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  • Question 1 - A 38-year-old woman comes to you with a swollen neck and upon examination,...

    Correct

    • A 38-year-old woman comes to you with a swollen neck and upon examination, you find an unusual neck mass that raises suspicion of thyroid cancer. You arrange for a fine-needle aspiration and a histology report from a thyroid lobectomy reveals chromatin clearing, nuclear shape alteration, and irregularity of the nuclear membrane. There is no evidence of C cell differentiation, and the patient has no family history of cancer. What is the most probable diagnosis?

      Your Answer: Papillary carcinoma of the thyroid

      Explanation:

      Thyroid cancer can take different forms, with papillary carcinoma being the most common and typically affecting women between 35 and 40 years old. This type of cancer has a good long-term prognosis. Medullary carcinoma arises from C cells that produce calcitonin and CEA, and can be sporadic or associated with a genetic syndrome. Follicular carcinoma is difficult to diagnose through FNA and requires a full histological specimen to confirm, with distinguishing features being vascular and capsule invasion. Anaplastic carcinoma is the most aggressive thyroid tumor, typically affecting older individuals and lacking biological features of the original thyroid cells. Thyroid lymphomas are rare and typically affect women over 50 with Hashimoto’s thyroiditis.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 2 - A 28-year-old woman has been living with type 1 diabetes mellitus for 15...

    Correct

    • A 28-year-old woman has been living with type 1 diabetes mellitus for 15 years and has been under your care for the past nine years. During this time, her HbA1c levels have fluctuated between 64 mmol/mol and 75 mmol/mol (20-42).
      Today, her blood pressure reads 130/84 mmHg. She has also noticed that her blood glucose levels at home have been fluctuating more than usual over the past three months. Additionally, she reports experiencing nausea after eating and requiring less food than usual to feel full.
      Upon conducting investigations, the following results were obtained:
      - Urea: 8.1 mmol/L (2.5-7.5)
      - Creatinine: 112 µmol/L (60-110)
      - Sodium: 138 mmol/L (137-144)
      - Potassium: 4.2 mmol/L (3.5-4.9)
      - Bicarbonate: 24 mmol/L (20-28)
      - HbA1c: 42 mmol/mol (20-42)
      - Urinalysis: Protein+
      What is the most likely cause of her symptoms?

      Your Answer: Delayed gastric emptying

      Explanation:

      Autonomic Neuropathy and Gastric Emptying

      People with a long history of diabetes may experience nausea after eating, along with a feeling of fullness and reduced appetite. These symptoms suggest reduced gastric emptying, which is often associated with autonomic neuropathy. Other symptoms that may be present include postural hypotension, gustatory sweating, diarrhea, or changes in bowel habits. To confirm the diagnosis, a barium swallow and meal may be necessary. It is important to recognize these symptoms and seek medical attention to manage the underlying condition.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 3 - A 38-year-old woman presents with a 6-month history of excessive sweating, palpitations, and...

    Correct

    • A 38-year-old woman presents with a 6-month history of excessive sweating, palpitations, and weight loss. She now complains of a headache. On examination, her blood pressure is 230/130 mmHg, with a postural drop to 180/110 mmHg. She has a bounding pulse of 115 bpm, a tremor, and appears pale. The rest of the examination is unremarkable. Which hormone is most likely responsible for her symptoms and signs?

      Your Answer: Catecholamines

      Explanation:

      Explanation of Hormones and their Role in Hypertension

      The patient’s symptoms suggest a rare tumour called phaeochromocytoma, which secretes catecholamines and causes malignant hypertension. Excess cortisol production in Cushing’s syndrome can also cause hypertension, but it does not explain the patient’s symptoms. Renin abnormalities can lead to hypertension, but it is not the cause of the patient’s symptoms. Hyperaldosteronism can also cause hypertension, but it does not explain the patient’s symptoms. Although hyperthyroidism can explain most of the patient’s symptoms, it is less likely to cause severe hypertension or headaches. Therefore, the patient’s symptoms are most likely due to the secretion of catecholamines from the phaeochromocytoma tumour.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 4 - A 39-year-old man comes to his GP complaining of sudden headaches accompanied by...

    Correct

    • A 39-year-old man comes to his GP complaining of sudden headaches accompanied by sweating and palpitations. Upon examination, the patient appears anxious and has a pale complexion. His blood pressure measures 240/200 mmHg, and a 24-hour urine collection shows increased levels of catecholamines. What is the probable cause of this man's hypertension?

      Your Answer: Phaeochromocytoma

      Explanation:

      Differentiating Causes of Hypertension: A Brief Overview

      Hypertension, or high blood pressure, is a common medical condition that affects millions of people worldwide. While there are many possible causes of hypertension, some are more common than others. In this article, we will discuss some of the most common causes of hypertension and how to differentiate them.

      Phaeochromocytoma is a tumour of the adrenal gland that can cause hypertension, headache, sweating, and anxiety. It is often associated with the 10% rule, which states that 10% of cases are extramedullary, 10% are malignant, 10% are familial, and 10% are bilateral.

      Conn syndrome, or primary aldosteronism, is characterized by hypertension, hypokalaemia, and metabolic alkalosis. The most common causes are aldosterone-producing adenomas and bilateral adrenal hyperplasia.

      Renal artery stenosis (RAS) is a major cause of renovascular hypertension. However, it is not associated with elevated catecholamines or the symptoms described.

      Polycystic kidney disease (PKD) is a genetic disorder that can cause hypertension due to progressive kidney enlargement. However, patients with PKD do not have elevated catecholamine levels.

      Cushing syndrome is caused by prolonged hypercortisolism and can cause centripetal obesity, secondary hypertension, glucose intolerance, proximal myopathy, and hirsutism. Sweating, palpitations, and elevated catecholamines are not typical of hypercortisolism.

      In conclusion, hypertension can have many different causes, and it is important to differentiate them to provide appropriate treatment. By understanding the characteristic features of each condition, healthcare professionals can make an accurate diagnosis and provide effective management.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 5 - A 36-year-old woman visits her new GP for routine blood tests after recently...

    Incorrect

    • A 36-year-old woman visits her new GP for routine blood tests after recently moving locations. She mentions that her previous GP had told her she had a ‘thyroid problem’ and had prescribed medication, but she cannot recall any further details. Her blood test results are as follows:
      Investigation Result Normal value
      Thyroid-stimulating hormone (TSH) 18 mu/l 0.5–5.5 mu/l
      Free thyroxine (T4) 9.2 pmol/l 9–18 pmol/l
      What could be the possible cause of these biochemical results?

      Your Answer: Secondary hypothyroidism

      Correct Answer: Poor compliance with thyroxine

      Explanation:

      Thyroid Function Tests: Understanding the Results

      Thyroid function tests are commonly used to diagnose and monitor thyroid disorders. The results of these tests can provide valuable information about the functioning of the thyroid gland. Here are some common thyroid function test results and what they may indicate:

      Poor Compliance with Thyroxine
      Patients who are not compliant with their thyroxine medication may only take it a few days before a routine blood test. This can result in normal thyroxine levels due to the supplementation, but the TSH levels may not have enough time to reach the normal range due to the required negative feedback.

      Sick Euthyroid Syndrome
      In this condition, all TSH, thyroxine, and T3 levels are low. However, the TSH level is often within the normal range. This condition is reversible upon recovery from the systemic illness.

      Thyrotoxicosis
      Thyrotoxicosis is characterized by low TSH and high T4 levels.

      Primary Hypothyroidism
      Primary hypothyroidism results in low T4 levels and subsequent high TSH levels due to negative feedback.

      Secondary Hypothyroidism
      In secondary hypothyroidism, both TSH and T4 levels are low. This condition occurs due to the failure of the anterior pituitary to secrete TSH despite adequate thyrotropin-releasing hormone (TRH) levels. TRH is elevated, but TSH, T3, and T4 are low, and TSH fails to rise even after a TRH stimulation test.

      Understanding the results of thyroid function tests can help healthcare providers diagnose and manage thyroid disorders effectively.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 6 - What are the symptoms of Addison's disease? ...

    Incorrect

    • What are the symptoms of Addison's disease?

      Your Answer: Hypertension

      Correct Answer: Hypoglycaemia

      Explanation:

      Addison’s Disease

      Addison’s disease is a condition that occurs when the adrenal cortex is destroyed, leading to a deficiency in glucocorticoid and mineralocorticoid. These hormones are essential for various bodily functions, including glucose production from amino acids. The symptoms of Addison’s disease include lethargy, fatigue, muscle weakness, dizziness, fainting, non-specific abdominal pain, and gastrointestinal disturbances such as diarrhea and vomiting. Signs of the condition include postural hypotension and hyperpigmentation.

      Biochemically, Addison’s disease is characterized by hyponatremia, hyperkalemia, and hypoglycemia. In the United Kingdom, the most common cause of primary adrenal insufficiency is autoimmune destruction of the adrenal cortex, which may be associated with other autoimmune diseases such as type 1 diabetes and autoimmune thyroid disease. Worldwide, tuberculosis is the leading cause of primary adrenal insufficiency. Other rare causes of the condition include congenital adrenal hyperplasia, HIV infection, infiltrating metastases, and haemochromatosis involving the adrenal glands.

      In summary, Addison’s disease is a condition that results from the destruction of the adrenal cortex, leading to a deficiency in essential hormones. The symptoms and signs of the condition can be varied, and the biochemical features include hyponatremia, hyperkalemia, and hypoglycemia. While autoimmune destruction of the adrenal cortex is the most common cause of primary adrenal insufficiency in the United Kingdom, tuberculosis is the leading cause worldwide. Other rare causes of the condition include congenital adrenal hyperplasia, HIV infection, infiltrating metastases, and haemochromatosis involving the adrenal glands.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - A 27-year-old woman visits her GP for a routine health examination before beginning...

    Incorrect

    • A 27-year-old woman visits her GP for a routine health examination before beginning a new job. During the examination, thyroid function tests are conducted on her serum, which reveal elevated thyroid-stimulating hormone (TSH), reduced total thyroxine (T4), reduced free T4, and reduced triiodothyronine (T3) uptake. What is the most probable clinical manifestation that this patient will exhibit?

      Your Answer:

      Correct Answer: Weight gain

      Explanation:

      Understanding the Symptoms of Hypothyroidism and Hyperthyroidism

      Hypothyroidism and hyperthyroidism are two conditions that affect the thyroid gland, resulting in a range of symptoms. In hypothyroidism, there is a decrease in T4/T3, leading to symptoms such as lethargy, weight gain, depression, sensitivity to cold, myalgia, dry skin, dry hair and/or hair loss, constipation, menstrual irregularities, carpal tunnel syndrome, memory problems, difficulty concentrating, and myxoedema coma (a medical emergency). On the other hand, hyperthyroidism results in an increase in thyroid hormones, causing symptoms such as hyperactivity, diarrhea, heat intolerance, and tachycardia. Understanding these symptoms can help in the diagnosis and management of these conditions.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 8 - A 44-year-old woman without prior medical history visits her primary care physician complaining...

    Incorrect

    • A 44-year-old woman without prior medical history visits her primary care physician complaining of hand pain and overall bone pain that has persisted for four weeks. She also reports experiencing pain in her groin that spreads to her lower back approximately 20 minutes before urination. Additionally, she has been experiencing frequent thirst despite drinking fluids regularly. Laboratory tests reveal hypercalcemia and hypophosphatemia. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Primary hyperparathyroidism

      Explanation:

      Diagnosis of Hyperparathyroidism

      Primary hyperparathyroidism is the most likely diagnosis for a patient presenting with hypercalcaemia, polydipsia, and renal calculus formation. This condition is typically caused by a parathyroid adenoma that secretes excess parathyroid hormone (PTH), leading to increased osteoclastic activity and bone resorption. PTH also increases calcium absorption from the intestines and renal activation of vitamin D, further contributing to hypercalcaemia. Hypophosphataemia is a common feature of hyperparathyroidism due to the promotion of renal phosphate excretion by PTH.

      Metastatic carcinoma and multiple myeloma are unlikely diagnoses for this patient as there is no evidence of malignancy in the patient’s history, and phosphate levels are typically normal or increased in these conditions. Secondary hyperparathyroidism, on the other hand, occurs as a compensatory mechanism for hypocalcaemia, which is not present in this patient. Chronic kidney disease is the most common cause of secondary hyperparathyroidism, which is associated with reduced activation of vitamin D and impaired calcium absorption.

      Overall, primary hyperparathyroidism is the most likely diagnosis for this patient based on their symptoms and laboratory results.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 9 - A 65-year-old individual with diabetes complains of difficulty reading newsprint. Fundoscopy reveals clouding...

    Incorrect

    • A 65-year-old individual with diabetes complains of difficulty reading newsprint. Fundoscopy reveals clouding of the lens, making it difficult to visualize the retina.
      What is the probable reason for this person's vision impairment?

      Your Answer:

      Correct Answer: Cataract

      Explanation:

      Premature Cataracts and their Association with Diabetes and Other Conditions

      Cataracts can develop prematurely in individuals with certain medical conditions such as diabetes, Cushing’s syndrome, and those who have undergone steroid therapy or experienced trauma. In such cases, it is important to treat the cataracts in order to properly evaluate the back of the eye for signs of diabetic retinopathy. This condition occurs when high blood sugar levels damage the blood vessels in the retina, leading to vision loss. Therefore, it is crucial to monitor the eyes of individuals with these medical conditions to ensure early detection and treatment of any potential complications.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 10 - A teenager comes to see you in general practice with a swelling in...

    Incorrect

    • A teenager comes to see you in general practice with a swelling in the region of their throat. They are worried because they have read about an extremely invasive cancer which is difficult to treat.
      Which of the following is the patient referring to?

      Your Answer:

      Correct Answer: Anaplastic thyroid cancer

      Explanation:

      Types of Thyroid Cancer and Their Prognosis

      Thyroid cancer is a type of cancer that affects the thyroid gland, a small butterfly-shaped gland located in the neck. There are different types of thyroid cancer, each with its own characteristics and prognosis.

      Anaplastic thyroid cancer is a rare but aggressive form of thyroid cancer that mostly affects the elderly. It presents as a hard mass within the thyroid and is responsible for a significant number of deaths from thyroid cancer.

      Follicular thyroid cancer is the second most common type of thyroid cancer. Although it is more aggressive than papillary thyroid cancer, it still has a good prognosis.

      Medullary thyroid cancer originates from the thyroid C cells and is associated with multiple endocrine neoplasia syndromes. Early diagnosis and treatment can improve the prognosis.

      Thyroid lymphoma is a rare form of lymphoma that affects the thyroid gland. It has a good prognosis with proper treatment.

      Papillary thyroid cancer is the most common type of thyroid cancer, occurring mostly in people between the ages of 25 and 50. It presents as an irregular mass arising from a normal thyroid and has a good prognosis.

      In summary, understanding the different types of thyroid cancer and their prognosis can help with early detection and treatment, leading to better outcomes for patients.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 11 - What role does adrenocorticotrophic hormone (ACTH) play in the body? ...

    Incorrect

    • What role does adrenocorticotrophic hormone (ACTH) play in the body?

      Your Answer:

      Correct Answer: Stimulation of the release of glucocorticoids

      Explanation:

      The Adrenal Cortex and Pituitary Gland

      The adrenal cortex is composed of two layers, the cortical and medullary layers. The zona glomerulosa of the adrenal cortex secretes aldosterone, while the zona fasciculata secretes glucocorticoids and the zona reticularis secretes adrenal androgens. However, both layers are capable of secreting both glucocorticoids and androgens. The release of glucocorticoids from the adrenal cortex is stimulated by ACTH.

      Antidiuretic hormone (ADH), also known as vasopressin, is secreted from the posterior pituitary and acts on the collecting ducts of the kidney to promote water reabsorption. Growth hormone, secreted by the anterior pituitary, promotes the growth of soft tissues. Prolactin secretion from the anterior pituitary is under inhibitory control from dopamine.

      In summary, the adrenal cortex and pituitary gland play important roles in regulating hormone secretion and bodily functions. The adrenal cortex is responsible for the secretion of aldosterone, glucocorticoids, and adrenal androgens, while the pituitary gland secretes ADH, growth hormone, and prolactin.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 12 - A 35-year-old woman presents to her general practice with a lump in her...

    Incorrect

    • A 35-year-old woman presents to her general practice with a lump in her neck. During examination, the GP observes a diffusely enlarged thyroid swelling with an audible bruit but no retrosternal extension. The patient reports no difficulty with breathing or swallowing. The patient appears underweight and anxious, with a pulse rate of 110 bpm and signs of proptosis, periorbital oedema, lid retraction and diplopia. The GP suspects hyperthyroidism and refers the patient to the Endocrinology Clinic.
      What is the most common cause of hyperthyroidism?

      Your Answer:

      Correct Answer: Graves' disease

      Explanation:

      Causes of Hyperthyroidism: Understanding the Different Factors

      Hyperthyroidism is a condition characterized by an overactive thyroid gland, which results in the production of too much thyroid hormone. There are several factors that can contribute to the development of hyperthyroidism, each with its own unique characteristics and symptoms. Here are some of the most common causes of hyperthyroidism:

      1. Graves’ Disease: This autoimmune disorder is responsible for around 75% of all cases of hyperthyroidism. It occurs when the immune system mistakenly attacks the thyroid gland, causing it to produce too much thyroid hormone. Patients with Graves’ disease may also experience eye symptoms, such as bulging eyes or double vision.

      2. Toxic Nodule: A toxic nodule is a benign growth on the thyroid gland that produces excess thyroid hormone. It accounts for up to 5% of cases of hyperthyroidism and can be treated with surgery or radioactive iodine.

      3. Toxic Multinodular Goitre: This condition is similar to a toxic nodule, but involves multiple nodules on the thyroid gland. It is the second most common cause of hyperthyroidism and can also be treated with surgery or radioactive iodine.

      4. Over-Treating Hypothyroidism: In some cases, treating an underactive thyroid gland (hypothyroidism) with too much thyroid hormone can result in symptoms of hyperthyroidism. This is known as thyrotoxicosis and can be corrected by adjusting the dosage of thyroid hormone medication.

      5. Medullary Carcinoma: This rare form of thyroid cancer develops from C cells in the thyroid gland and can cause high levels of calcitonin. However, it does not typically result in hyperthyroidism.

      Understanding the different causes of hyperthyroidism is important for proper diagnosis and treatment. If you are experiencing symptoms of hyperthyroidism, such as weight loss, rapid heartbeat, or anxiety, it is important to speak with your healthcare provider to determine the underlying cause and develop an appropriate treatment plan.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 13 - A 14-year-old boy is suspected of suffering from insulin-dependent diabetes. He undergoes a...

    Incorrect

    • A 14-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?

      Your Answer:

      Correct Answer: A peak of plasma glucose occurring between 1 and 2 h that stays high

      Explanation:

      Interpreting Glucose Levels in Insulin-Dependent Diabetes

      Insulin-dependent diabetes is a condition that affects the body’s ability to regulate glucose levels. When interpreting glucose levels in insulin-dependent diabetes, there are several key factors to consider.

      One important factor is the peak of plasma glucose that occurs between 1 and 2 hours after glucose ingestion. In normal individuals, this peak is typically sharper and occurs earlier than in insulin-dependent diabetics. In diabetics, the plasma glucose remains elevated throughout the 4-hour test period.

      Another factor to consider is the presence or absence of an overshoot in the decline of plasma glucose at 3.5 hours. This overshoot, which is seen in normal individuals but not in diabetics, is a result of a pulse of insulin secretion.

      A plasma glucose level of 4 mmol/l at zero time is unlikely in a diabetic patient, as they typically have high basal glucose levels. Similarly, a glucose concentration of 5.2 mmol/l at 4 hours is not expected in insulin-dependent diabetics, as their plasma glucose levels remain elevated throughout the test period.

      Finally, it is important to consider the HbA1c level, which reflects average blood glucose levels over the past 2-3 months. In a diabetic patient who has been untreated for several weeks, the HbA1c would likely be elevated.

      Overall, interpreting glucose levels in insulin-dependent diabetes requires careful consideration of multiple factors to accurately assess the patient’s condition.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 14 - A 50-year-old man comes to the clinic complaining of headaches. His blood pressure...

    Incorrect

    • A 50-year-old man comes to the clinic complaining of headaches. His blood pressure measures 168/100 mmHg. Routine tests show sodium levels of 142 mmol/l (136–145), potassium levels of 2.8 mmol/l (3.5–5.0), chloride levels of 100 mmol/l (95–105), and normal levels of urea and creatinine. His plasma renin levels are undetectable, and his aldosterone levels are elevated. What is the most probable cause of his hypertension?

      Your Answer:

      Correct Answer: Primary hyperaldosteronism

      Explanation:

      Differentiating Primary Hyperaldosteronism from Other Causes of Hypertension

      Primary hyperaldosteronism, also known as Conn’s syndrome, is a condition characterized by elevated aldosterone levels leading to low renin levels through negative feedback loops. This is the primary cause of hypertension in this condition. On the other hand, secondary hypertension can be caused by various conditions such as acromegaly, Cushing’s syndrome, and phaeochromocytoma. However, these conditions are not associated with low renin and elevated aldosterone levels. Renal artery stenosis, on the other hand, causes both high renin and aldosterone levels, leading to secondary hyperaldosteronism. Therefore, differentiating primary hyperaldosteronism from other causes of hypertension is crucial in determining the appropriate treatment plan.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 15 - A 26-year-old man with a 10-year history of type I diabetes presents with...

    Incorrect

    • A 26-year-old man with a 10-year history of type I diabetes presents with a 1-day history of vomiting and a 4-day history of myalgia and sore throat. He appears dehydrated, BP 120/74 mmHg, pulse 101 bpm, temperature 37.9 °C, oxygen saturation 97% on room air. There is mild erythema in his throat and nil else to find on clinical examination. The following are his laboratory investigations:
      Investigation Result Normal value
      pH 7.12 7.35–7.45
      Ketones 5 mmol/l <0.6
      Glucose 32 mmol/l 4–10 mmol/l
      Potassium 4.2 mmol/l 3.5–5 mmol/l
      Bicarbonate 10 mmol/l 24–30 mmol/l
      Base excess -5 mEq/l −2 to +2 mEg/l
      C-reactive protein (CRP) 22 mg/l 0–10 mg/l
      White Cell Count (WCC) 12.7 × 109/l 4-11
      Which of the following initial treatment plans should be commenced?

      Your Answer:

      Correct Answer: IV insulin, IV fluids, potassium supplementation

      Explanation:

      Management of Diabetic Ketoacidosis

      Diabetic ketoacidosis (DKA) is a serious complication of diabetes that requires prompt management. The initial stages of DKA should involve the administration of IV insulin, IV fluids, and potassium supplementation. If the patient’s systolic blood pressure is below 90 mmHg, 500 ml of IV sodium chloride 0.9% should be given over 10-15 minutes, with repeat doses if necessary. Once blood pressure is over 90 mmHg, sodium chloride 0.9% should be given by intravenous infusion at a rate that replaces the deficit and provides maintenance. Potassium chloride should be included in the fluids, unless anuria is suspected or potassium levels are above 5.5 mmol/l. IV insulin should be infused at a fixed rate of 0.1 units/kg/hour, diluted with sodium chloride 0.9% to a concentration of 1 unit/ml.

      If there are no signs of bacterial infection, antibiotics may not be necessary. In cases where there are symptoms of viral infection, such as a red sore throat and myalgia, IV antibiotics may not be required. Subcutaneous rapid-acting insulin should not be used, as IV insulin is more effective in rapidly treating hyperglycemia and can be titrated as needed on an hourly basis. Oral antibiotics may be considered if there are signs of bacterial infection.

      In cases where the patient has established diabetes, long-acting insulin should be continued even if on IV insulin. Once blood glucose levels fall below 14 mmol/litre, glucose 10% should be given by intravenous infusion at a rate of 125 ml/hour, in addition to the sodium chloride 0.9% infusion. Glucose levels of 32 require the use of saline with potassium initially. Overall, prompt and appropriate management of DKA is crucial in preventing serious complications and improving patient outcomes.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 16 - What is the most frequent organic cause of anxiety symptoms? ...

    Incorrect

    • What is the most frequent organic cause of anxiety symptoms?

      Your Answer:

      Correct Answer: Hypoglycaemia

      Explanation:

      Organic Causes of Anxiety

      Anxiety can be caused by various factors, including organic causes. One of the more common organic causes of anxiety is hypoglycaemia. However, there are other organic causes that can also lead to anxiety. These include alcohol withdrawal, drug intoxication or withdrawal, thyroxine, and paroxysmal supraventricular tachycardias. While phaeochromocytoma is a rare cause of anxiety, carcinoid does not cause anxiety at all. It is important to note that carcinoma of the bronchus and hyperparathyroidism are more likely to present with depression rather than anxiety.

      It is crucial to identify the underlying cause of anxiety to provide appropriate treatment. If an organic cause is suspected, further evaluation and testing may be necessary to determine the root cause of the anxiety. By addressing the underlying cause, it may be possible to alleviate or even eliminate the symptoms of anxiety. Therefore, it is important to consider all possible causes of anxiety, including organic causes, to provide the best possible care for patients.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 17 - A 46-year-old man with type 1 diabetes for 20 years presents with an...

    Incorrect

    • A 46-year-old man with type 1 diabetes for 20 years presents with an ulcer on his right foot. The ulcer is located on the outer aspect of his right big toe and measures 2 cm in diameter. Despite having palpable peripheral pulses, he experiences peripheral neuropathy to the mid shins. The ulcer has an erythematosus margin and is covered by slough. What is the most probable infective organism?

      Your Answer:

      Correct Answer: Staphylococcus aureus

      Explanation:

      Diabetic foot ulcers can be categorized into neuropathic and ischemic. Infections in diabetic feet are serious and can range from superficial to deep infections and gangrene. Diabetics are more susceptible to foot ulceration due to neuropathy, vascular insufficiency, and reduced neutrophil function. Local signs of wound infection include friable granulation tissue, yellow or grey moist tissue, purulent discharge, and an unpleasant odor. Methicillin-resistant Staphylococcus aureus (MRSA) is more common in previously hospitalized or antibiotic-treated patients. Deep swab and tissue samples should be sent for culture and broad-spectrum antibiotics started if infection is suspected. Urgent surgical intervention is indicated for a large area of infected sloughy tissue, localised fluctuance and expression of pus, crepitus in the soft tissues on radiological examination, and purplish discoloration of the skin. Antibiotic treatment should be tailored according to the clinical response, culture results, and sensitivity. If osteomyelitis is present, surgical resection should be considered, and antibiotics continued for four to six weeks.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 18 - What is a true statement about bariatric surgery? ...

    Incorrect

    • What is a true statement about bariatric surgery?

      Your Answer:

      Correct Answer: Reduces cardiovascular mortality

      Explanation:

      Bariatric Surgery for Obesity: Benefits, Risks, and Complications

      Bariatric surgery is the most effective and long-lasting intervention for obesity, providing significant weight loss and resolution of associated health problems. The Swedish Obesity Study found that bariatric surgery reduced cardiovascular events and mortality rates for up to 15 years compared to standard care. While adolescents face social, psychological, and developmental challenges, they are not excluded from surgery, and some hospitals offer specialized programs for younger patients. Candidates for surgery typically have a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with serious co-morbidities such as sleep apnea or type 2 diabetes.

      Post-operative mortality rates range from 0.1-2%, and the risk of complications is similar to other major abdominal surgeries. However, if complications do occur, there is a higher likelihood of intervention. The specific complications depend on the type of procedure used. For laparoscopic adjustable gastric band surgery, complications may include band slippage, erosion, infection, pouch dilation, band/tubing leak, and megaoesophagus. For laparoscopic roux en y gastric bypass, complications may include stomal stenosis, internal hernia, and malnutrition. For laparoscopic sleeve gastrectomy, complications may include reflux, staple line leak, sleeve dilation, and weight gain. It is important for patients to understand the potential risks and benefits of bariatric surgery before making a decision.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 19 - A 38-year-old female patient visits her doctor's office for a follow-up appointment. She...

    Incorrect

    • A 38-year-old female patient visits her doctor's office for a follow-up appointment. She was recently diagnosed with hypothyroidism and is currently taking a daily dose of 100 micrograms of thyroxine. The doctor has access to the patient's thyroid function and other test results from the previous week.

      Which test would be most effective in monitoring the patient's progress and treatment?

      Your Answer:

      Correct Answer: Thyroid stimulating hormone (TSH) levels

      Explanation:

      Thyroxine and TSH Levels in Hypothyroidism

      Thyroxine is a medication that can help reduce the high levels of thyroid-stimulating hormone (TSH) that are often seen in individuals with hypothyroidism. When TSH levels are high, it indicates that the thyroid gland is not producing enough thyroid hormones, which can lead to a range of symptoms such as fatigue, weight gain, and depression. By taking thyroxine, individuals with hypothyroidism can help regulate their TSH levels and improve their overall health.

      To monitor the effectiveness of thyroxine treatment, doctors often use TSH as a key monitoring test. The goal is to get TSH levels into the normal range, which indicates that the thyroid gland is producing enough hormones. Other tests that may be used in the initial investigation and diagnosis of hypothyroidism include triiodothyronine, free thyroxine (T4), thyroid peroxidase antibody, and protein-bound iodine levels. By using a combination of these tests, doctors can get a better of a patient’s thyroid function and develop an appropriate treatment plan.

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      • Endocrinology
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  • Question 20 - A 30-year-old female patient complains of anxiety and weight loss. During the examination,...

    Incorrect

    • A 30-year-old female patient complains of anxiety and weight loss. During the examination, a fine tremor of the outstretched hands, lid lag, and a moderate goitre with a bruit are observed. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Graves' disease

      Explanation:

      Thyroid Disorders and their Differentiation

      Thyroid disorders are a common occurrence, and their diagnosis is crucial for effective treatment. One such disorder is Graves’ disease, which is characterized by a goitre with a bruit. Unlike MNG, Graves’ disease is associated with angiogenesis and thyroid follicular hypertrophy. Other signs of Graves’ disease include eye signs such as conjunctival oedema, exophthalmos, and proptosis. Additionally, pretibial myxoedema is a dermatological manifestation of this disease.

      De Quervain’s thyroiditis is another thyroid disorder that follows a viral infection and is characterized by painful thyroiditis. Hashimoto’s thyroiditis, on the other hand, is a chronic autoimmune degradation of the thyroid. Multinodular goitre (MNG) is the most common form of thyroid disorder, leading to the formation of multiple nodules over the gland. Lastly, a toxic thyroid nodule is a solitary lesion on the thyroid that produces excess thyroxine.

      In conclusion, the different types of thyroid disorders and their symptoms is crucial for accurate diagnosis and effective treatment.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 21 - A 55-year-old male with a history of diabetes mellitus for five years presents...

    Incorrect

    • A 55-year-old male with a history of diabetes mellitus for five years presents with restricted myocardial dysfunction and skin pigmentation. His ALT level is elevated at 153 IU/L. What is the most suitable investigation for this patient?

      Your Answer:

      Correct Answer: Serum ferritin and transferrin saturation

      Explanation:

      Haemochromatosis

      Haemochromatosis is a genetic condition that results in excessive absorption of iron from the gut, leading to the accumulation of iron in various organs such as the liver, pancreas, heart, endocrine glands, and joints. This condition is characterized by extremely high levels of ferritin (>500) and transferrin saturation. The transferrin saturation test measures the amount of iron bound to the protein that carries iron in the blood, while the total iron binding capacity (TIBC) test determines how well the blood can transport iron. The serum ferritin test, on the other hand, shows the level of iron in the liver.

      To confirm the diagnosis of haemochromatosis, a test to detect the HFE mutation is usually conducted. If the mutation is not present, then hereditary haemochromatosis is not the cause of the iron build-up. It is important to note that other conditions such as Wilson’s disease, hepatitis B infection, and autoimmune hepatitis may also cause raised ferritin levels, but they do not result in myocardial dysfunction or skin pigmentation.

      In summary, haemochromatosis is a genetic disorder that causes excessive absorption of iron from the gut, leading to the accumulation of iron in various organs. Diagnosis is usually confirmed through a combination of tests, including the HFE mutation test, transferrin saturation test, TIBC test, and serum ferritin test. It is important to differentiate haemochromatosis from other conditions that may cause similar symptoms but require different treatment approaches.

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      • Endocrinology
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  • Question 22 - A 35-year-old patient presents to her doctor with complaints of excessive sweating and...

    Incorrect

    • A 35-year-old patient presents to her doctor with complaints of excessive sweating and feeling very warm. Upon examination, no significant thyroid nodule is observed. The patient's blood tests reveal the following results:
      Investigation Result Normal value
      Thyroid-stimulating hormone (TSH) < 0.1 µU/l 0.4–4.0 µU/l
      Free thyroxine (T4) 30 pmol/l 10–20 pmol/l
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Graves’ disease

      Explanation:

      Thyroid Disorders: Causes and Symptoms

      Thyroid disorders are common and can cause a range of symptoms. Here are some of the most common thyroid disorders and their associated symptoms:

      1. Graves’ disease: This is the most common cause of thyrotoxicosis in the UK. Symptoms include a low TSH and an elevated T4.

      2. De Quervain’s thyroiditis: This is a subacute thyroiditis that can cause hypothyroidism.

      3. Hashimoto’s thyroiditis: This is an autoimmune disorder that is associated with hypothyroidism.

      4. Toxic multinodular goitre: There is insufficient information to suggest that the patient has this condition.

      5. Thyroid adenoma: Patients usually present with a neck lump, which is not seen in this case.

      If you are experiencing any symptoms of a thyroid disorder, it is important to speak with your healthcare provider for proper diagnosis and treatment.

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      • Endocrinology
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  • Question 23 - A 65-year-old man visits his GP complaining of erectile dysfunction that has been...

    Incorrect

    • A 65-year-old man visits his GP complaining of erectile dysfunction that has been ongoing for the past year. He has no prior history of this issue and is greatly troubled by it. The patient has a medical history of type II diabetes mellitus, hypertension, ischaemic heart disease, and poor urinary flow. He also had a thyroidectomy a few years ago, the reason for which is unclear. He is currently taking insulin, gliclazide, amlodipine, and aspirin. His most recent HbA1c was 12.1% or 108 mmol/mol. What is the probable cause of his erectile dysfunction?

      Your Answer:

      Correct Answer: Diabetes

      Explanation:

      Medical Conditions and Erectile Dysfunction: Understanding the Causes

      Erectile dysfunction is a common condition that affects many men, and it can be caused by a variety of medical conditions. Understanding the underlying causes of erectile dysfunction is important for effective treatment. Here are some common medical conditions that can lead to erectile dysfunction:

      Diabetes: Diabetes is a major risk factor for erectile dysfunction. Autonomic neuropathy, a microvascular complication of diabetes, can cause symptoms such as erectile dysfunction. Poor control of diabetes can make this condition worse.

      Ischaemic heart disease: While ischaemic heart disease itself does not cause erectile dysfunction, risk factors such as diabetes and hypertension can make this condition worse. Proper management of these conditions is important for overall health and sexual function.

      Thyroidectomy: A previous thyroidectomy may have been performed for an overactive thyroid or a thyroid nodule, but it is not a direct cause of erectile dysfunction.

      Prostatic hyperplasia: Prostatic hyperplasia is a common condition among elderly men, but it is not typically associated with erectile dysfunction.

      Hypertension: Hypertension increases the risk for diabetes in non-diabetics, and diabetes can cause erectile dysfunction. However, hypertension itself is not a direct cause of erectile dysfunction.

      In conclusion, understanding the underlying medical conditions that can cause erectile dysfunction is important for proper diagnosis and treatment. Proper management of these conditions can improve overall health and sexual function.

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      • Endocrinology
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  • Question 24 - A 32-year-old woman visits her GP with complaints of palpitations, tremors, sweating, and...

    Incorrect

    • A 32-year-old woman visits her GP with complaints of palpitations, tremors, sweating, and diarrhoea. She has a medical history of gestational hypertension and type 1 diabetes, which is managed with insulin. The patient gave birth to her first child 8 weeks ago without any complications.

      Upon examination, the patient is alert and oriented. Her vital signs are as follows: heart rate of 109 bpm, respiratory rate of 19 breaths/minute, temperature of 37.7ºC, oxygen saturation of 98%, blood pressure of 129/88 mmHg, and blood glucose of 4 mmol/L.

      What is the most likely diagnosis, and what is the appropriate treatment?

      Your Answer:

      Correct Answer: Propranolol

      Explanation:

      The recommended treatment for the thyrotoxicosis phase of postpartum thyroiditis is typically propranolol alone. This is because the condition is usually temporary and self-resolving, with thyroid function returning to normal within a year after childbirth. Carbimazole is not necessary as it is typically reserved for more severe cases of hyperthyroidism. Dexamethasone is not appropriate as it is used to treat thyroid storm, a complication of thyrotoxicosis that is not present in this case. Levothyroxine is also not indicated as it is used to treat hypothyroidism, which is the opposite of the patient’s current condition.

      Understanding Postpartum Thyroiditis: Stages and Management

      Postpartum thyroiditis is a condition that affects some women after giving birth. It is characterized by three stages: thyrotoxicosis, hypothyroidism, and normal thyroid function. During the thyrotoxicosis phase, the thyroid gland becomes overactive, leading to symptoms such as anxiety, palpitations, and weight loss. In the hypothyroidism phase, the thyroid gland becomes underactive, causing symptoms such as fatigue, weight gain, and depression. However, in the final stage, the thyroid gland returns to normal function, although there is a high recurrence rate in future pregnancies.

      Thyroid peroxidase antibodies are found in 90% of patients with postpartum thyroiditis, which suggests an autoimmune component to the condition. Management of postpartum thyroiditis depends on the stage of the condition. During the thyrotoxic phase, symptom control is the main focus, and propranolol is typically used. Antithyroid drugs are not usually used as the thyroid gland is not overactive. In the hypothyroid phase, treatment with thyroxine is usually necessary to restore normal thyroid function.

      It is important to note that many causes of hypothyroidism may have an initial thyrotoxic phase, as shown in a Venn diagram. Therefore, it is crucial to properly diagnose and manage postpartum thyroiditis to ensure the best possible outcomes for both the mother and the baby.

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      • Endocrinology
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  • Question 25 - A 32-year-old woman visits her GP after experiencing sudden hair growth, specifically on...

    Incorrect

    • A 32-year-old woman visits her GP after experiencing sudden hair growth, specifically on her face. She is feeling increasingly self-conscious about it and wants to address the issue. Blood tests were conducted, revealing an elevated testosterone level of 9.8 nmol/l (reference range 0.8-3.1 nmol/l). What is the next course of action in managing her condition?

      Your Answer:

      Correct Answer: Refer to Endocrinology as a suspected cancer referral

      Explanation:

      Referral for Suspected Androgen-Secreting Tumour in a Patient with Hirsutism

      This patient presents with sudden-onset hair growth and a raised testosterone level, which raises suspicion for an androgen-secreting tumour. An urgent referral for further investigation is necessary to rule out malignancy. While polycystic ovary syndrome can also cause hirsutism, the patient’s testosterone level warrants exclusion of a tumour. Topical eflornithine may provide symptomatic relief, but it is not a substitute for further investigation. Routine referral to endocrinology is not appropriate in this case, as it may delay diagnosis and treatment of a potential malignancy.

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      • Endocrinology
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  • Question 26 - A 52-year-old woman presents with complaints of irregular periods, weight loss, and excessive...

    Incorrect

    • A 52-year-old woman presents with complaints of irregular periods, weight loss, and excessive sweating. She reports that her symptoms have been gradually worsening over the past few months and she also experiences itching. During the examination, her blood pressure is measured at 140/80 mmHg and her resting pulse is 95 bpm.
      What is the most suitable test to perform for this patient?

      Your Answer:

      Correct Answer: Thyroid-stimulating hormone (TSH) and T4 levels

      Explanation:

      Investigations for Suspected Endocrine Disorder

      When a patient presents with signs and symptoms of an endocrine disorder, several investigations may be necessary to confirm the diagnosis. Here are some tests that may be useful in different scenarios:

      Thyroid-stimulating hormone (TSH) and T4 levels: These tests are essential when thyrotoxicosis is suspected. In rare cases, pruritus may also occur as a symptom.

      Plasma renin and aldosterone levels: This investigation may be useful if Conn syndrome is suspected, but it is not necessary in patients without significant hypertension. Electrolyte levels should be checked before this test.

      Full blood count and ferritin levels: These tests may be helpful in checking for anaemia, but they are less appropriate than TSH/T4 levels.

      Midnight cortisol level: This test is useful when Cushing’s syndrome is suspected. In this case, the only symptom that is compatible with this disorder is irregular menses.

      Test the urine for 24-hour free catecholamines: This test is used to investigate suspected phaeochromocytoma, which can cause similar symptoms to those seen in this case. However, hypertension is an important feature that is not present in this patient.

      In conclusion, the choice of investigations depends on the suspected endocrine disorder and the patient’s clinical presentation.

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      • Endocrinology
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  • Question 27 - A mother brings her 9-month-old baby to clinic for a check-up. His prior...

    Incorrect

    • A mother brings her 9-month-old baby to clinic for a check-up. His prior medical history has been unremarkable and his immunisations are up-to-date. The mother is concerned about his growth. After you determine that the baby has grown appropriately since the last visit and is unchanged from the 50th centile, you provide the mother with advice regarding growth.
      What signalling pathway does growth hormone (GH) use?

      Your Answer:

      Correct Answer: A tyrosine kinase receptor that uses the JAK/STAT pathway

      Explanation:

      Comparison of Second Messenger Systems and Receptor Types in Hormonal Signaling

      Hormones utilize various signaling pathways to transmit their messages to target cells. One important aspect of hormonal signaling is the use of second messengers, which relay the hormone signal from the cell surface to the intracellular environment. Here, we compare and contrast the second messenger systems and receptor types used by different hormones.

      Growth hormone (GH) and prolactin both use the tyrosine kinase receptor, followed by activation of Janus kinase (JAK), signal transduction, and activation of transcription (STAT). In contrast, platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), insulin-like growth factor 1 (IGF-1), and insulin use the MAP kinase or RAS system. Aldosterone uses steroid receptors, while GH uses the tyrosine kinase receptor.

      Inositol trisphosphate (IP3) works as a second messenger for hypothalamic hormones such as gonadotropin-releasing hormone (GnRH), growth hormone-releasing hormone (GHRH), thyrotropin-releasing hormone (TRH), and pituitary hormones such as antidiuretic hormone (ADH) and oxytocin.

      Cyclic guanosine monophosphate (cGMP) is a second messenger that activates protein kinases and mediates endothelium-derived relaxing factor (EDRF), atrial natriuretic peptide (ANP), and nitric oxide.

      Cyclic adenosine monophosphate (cAMP) is a second messenger of follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), human chorionic gonadotropin (hCG), and several other hormones, but not GH.

      In summary, different hormones use distinct second messenger systems and receptor types to transmit their signals, highlighting the complexity and diversity of hormonal signaling pathways.

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      • Endocrinology
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  • Question 28 - A 50-year-old woman has been diagnosed with Addison's disease. What would be advantageous...

    Incorrect

    • A 50-year-old woman has been diagnosed with Addison's disease. What would be advantageous to prescribe for her along with hydrocortisone?

      Your Answer:

      Correct Answer: Fludrocortisone

      Explanation:

      Medications for Addison’s Disease: What Works and What Doesn’t

      Addison’s disease is a condition where the adrenal glands do not produce enough hormones. Patients with this condition require replacement therapy with both glucocorticoid and mineralocorticoid medications. Fludrocortisone is a common mineralocorticoid replacement therapy used in Addison’s disease. However, medications such as aspirin, the combined oral contraceptive pill, and the progesterone only pill have no role in treating this condition. Additionally, dexamethasone is not used as a replacement therapy for Addison’s disease. It is important for patients with Addison’s disease to work closely with their healthcare provider to determine the appropriate medications for their individual needs.

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      • Endocrinology
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  • Question 29 - A 42-year-old teacher visits her GP, complaining of hot flashes and night sweats....

    Incorrect

    • A 42-year-old teacher visits her GP, complaining of hot flashes and night sweats. She suspects that she may be experiencing symptoms of menopause. Can you identify which set of results below are consistent with postmenopausal values?

      A: FSH (follicular phase 2.9-8.4 U/L) 0.5
      LH (follicular phase 1.3-8.4 U/L) 1.1
      Oestrogen (pmol/L) 26
      Progesterone (pmol/L) <5

      B: FSH (follicular phase 2.9-8.4 U/L) 0.5
      LH (follicular phase 1.3-8.4 U/L) 1.2
      Oestrogen (pmol/L) 120
      Progesterone (pmol/L) 18

      C: FSH (follicular phase 2.9-8.4 U/L) 68
      LH (follicular phase 1.3-8.4 U/L) 51
      Oestrogen (pmol/L) 42
      Progesterone (pmol/L) <5

      D: FSH (follicular phase 2.9-8.4 U/L) 1.0
      LH (follicular phase 1.3-8.4 U/L) 0.8
      Oestrogen (pmol/L) 250
      Progesterone (pmol/L) 120

      E: FSH (follicular phase 2.9-8.4 U/L) 8.0
      LH (follicular phase 1.3-8.4 U/L) 7.2
      Oestrogen (pmol/L) 144
      Progesterone (pmol/L) <5

      Your Answer:

      Correct Answer: C

      Explanation:

      postmenopausal Blood Tests

      postmenopausal blood tests often reveal elevated levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), as well as low levels of estrogen. These changes in hormone levels are responsible for most of the symptoms associated with menopause, which can be difficult to diagnose. However, once characteristic symptoms are well-established, gonadotrophin levels are typically significantly elevated.

      The menopause is defined as the date of a woman’s last period, without further menses for at least a year. As such, the diagnosis can only be made retrospectively. Prior to menopause, women may experience irregular menstruation, heavy bleeding, and mood-related symptoms. While fertility is greatly reduced during this time, there is still some risk of pregnancy, and many healthcare providers recommend continuing contraception for a year after the last menstrual period.

      In summary, postmenopausal blood tests can provide valuable information about a woman’s hormone levels and help diagnose menopause. However, it’s important to recognize that menopause is a gradual process that can be accompanied by a range of symptoms. Women should work closely with their healthcare providers to manage these symptoms and ensure their ongoing health and well-being.

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      • Endocrinology
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  • Question 30 - What is the recommended course of treatment for a 16-year-old boy with Reifenstein...

    Incorrect

    • What is the recommended course of treatment for a 16-year-old boy with Reifenstein syndrome who has hypospadias, micropenis, and small testes in the scrotum?

      Your Answer:

      Correct Answer: Testosterone replacement

      Explanation:

      Management of Reifenstein Syndrome: Hormonal and Surgical Options

      Reifenstein syndrome is a rare X-linked genetic disease that results in partial androgen insensitivity. In phenotypic males with this condition, testosterone replacement therapy is recommended to increase the chances of fertility. However, if the patient had been raised as a female and chose to continue this way, oestrogen replacement therapy would be appropriate. Surgical management may be necessary if the patient has undescended testes, but in this case, orchidectomy is not indicated as the patient has small testes in the scrotum. While psychological counselling is always necessary, it is not the first line of treatment. Overall, the management of Reifenstein syndrome involves a combination of hormonal and surgical options tailored to the individual patient’s needs.

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      • Endocrinology
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