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QUESTION NO: 1
A 61-year-old woman was referred to the blood pressure clinic because of refractory hypertension. One year previously, her blood pressure, urea and electrolytes had been normal. Her current therapy included verapamil modified-release 240 mg daily and doxazosin 16 mg daily.
On examination, she was 1.63 m tall and weighed 90 kg with an elevated waist to hip ratio. Her blood pressure was 182/94 mmHg supine.
Investigations:
serum sodium137 mmol/L (137-144)
serum potassium2.8 mmol/L (3.5-4.9)
serum creatinine79 umol/L (60-110)
plasma renin activity (after 30 min supine)<1.1 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)<135 pmol/L (135-400)
What is the most appropriate investigation?
A. 24-h urinary electrolytes
B. 24-h urine to assess free cortisol:cortisone ratio
C. analysis of the SCNN1B and SCNN1G genes
D. overnight dexamethasone suppression test
E. repeat renin and aldosterone concentrations after stopping verapamil for 2 weeks
Answer: D
QUESTION NO: 2
A 19-year-old man was seen in the diabetes clinic. He had lost 2 kg in weight since the diagnosis of diabetes mellitus 18 months previously. At presentation, his body mass index was 33 kg/m2 (18-
25), his random plasma glucose was 18.0 mmol/L and his haemoglobin A1c was 56 mmol/mol (20-
42). He was taking gliclazide, and metformin had been added later. His father and grandfather had developed diabetes mellitus during their twenties.
Investigations:
haemoglobin A1c56 mmol/mol (20-42)
serum C-peptide301 pmol/L (180-360)
anti-glutamic acid decarboxylase (GAD)
antibodiesnegative
What is the most likely diagnosis?
A. chronic pancreatitis
B. latent-onset diabetes of autoimmunity
C. maturity-onset diabetes of the young
D. type 1 diabetes mellitus
E. type 2 diabetes mellitus
Answer: C
QUESTION NO: 3
A 17-year-old boy with a 7-year history of type 1 diabetes mellitus was transferred to the adolescent diabetes clinic. He had a history of poor clinic attendance. He admitted to having lost weight recently. His eyes had been photographed by a community ophthalmologist 1 week previously. A photograph of the right fundus is shown (see image).
Investigations:
haemoglobin A1c104 mmol/mol (20-42)
What is the most likely explanation for the retinal appearance?
A. benign choroidal naevus
B. drusen
C. macular oedema
D. preproliferative diabetic retinopathy
E. retinitis pigmentosa
Answer: A
QUESTION NO: 4
A 30-year-old man was reviewed in the diabetes clinic. He had type 1 diabetes mellitus of 6 months' duration, treated with subcutaneous insulin in a basal bolus regimen (short-acting insulin three times daily; long-acting insulin once daily).
Investigations:
haemoglobin A1c52 mmol/mol (20-42)
At what arterialised venous blood glucose threshold would a patient typically expect to develop neuroglycopenic symptoms?
A. <2.3 mmol/L
B. 2.3-2.6 mmol/L
C. 2.7-3.0 mmol/L
D. 3.1-3.4 mmol/L
E. 3.5-3.9 mmol/L
Answer: C
QUESTION NO: 5
A 16-year-old boy was referred to the endocrine clinic. He was concerned about his growth and pubertal development. He was well with no significant medical history. He had felt his development had lagged behind his peers for the previous 2 years and he had been the shortest in his class for some time and was being bullied.
General examination was normal. His height was 1.53 m and weight 52.4 kg. He had Tanner stage 3 genitalia and pubic hair. Axillary hair was present. Testicular volumes were 6 mL bilaterally.
Investigations:
serum testosterone4.4 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone2.5 U/L (1.0-7.0)
plasma luteinising hormone1.8 U/L (1.0-10.0)
serum insulin-like growth factor 134.5 nmol/L (9.3-56.0)
insulin tolerance test:
What is the most appropriate treatment?
A. growth hormone 0.4 mg subcutaneously per day
B. hydrocortisone 15 mg am, 5 mg pm
C. reassure and review
D. testosterone 50 mg intramuscularly per month
E. testosterone 250 mg intramuscularly per month
Answer: D
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Updated: May 27, 2022