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QUESTION NO: 1
A 75-year-old woman presented with a 4-week history of lethargy. Her medical history was unremarkable and she took no medication.
On examination, her blood pressure was 140/70 mmHg lying. She was euvolaemic.
Investigations:
serum sodium120 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine75 umol/L (60-110)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol450 nmol/L (200-700)
serum cortisol (30 min after tetracosactide)600 nmol/L (>550)
serum thyroid-stimulating hormone2.5 mU/L (0.4-5.0)
serum free T416.9 pmol/L (10.0-22.0)
urinary sodium70 mmol/L
What is the most appropriate initial management?
A. demeclocycline
B. fluid restriction
C. hydrocortisone
D. intravenous sodium chloride 0.9%
E. tolvaptan
Answer: B
QUESTION NO: 2
A 73-year-old man had been attending the diabetes clinic for 6 weeks with an ulcer on his right second metatarsal head. He had been receiving regular podiatry and offloading.
What new feature in the appearance of his foot is most likely to suggest the need to start antibiotics?
A. increase in ulcer size
B. pain around ulcer
C. skin redness around ulcer
D. tracking sinus
E. ulcer probing to bone
Answer: C
QUESTION NO: 3
A 28-year-old woman presented to the emergency department with a 3-day history of abdominal pain. Her past medical history included intermenstrual bleeding, and she was undergoing
6-monthly renal ultrasound surveillance for a cystic lesion.
Investigations:
serum creatinine84 umol/L (60-110)
serum corrected calcium3.20 mmol/L (2.20-2.60)
serum phosphate0.7 mmol/L (0.8-1.4)
plasma parathyroid hormone19.5 pmol/L (0.9-5.4)
What is the most likely condition underlying the clinical presentation?
A. Cowden's syndrome
B. hyperparathyroidism-jaw tumour syndrome
C. multiple endocrine neoplasia type 1
D. multiple endocrine neoplasia type 2B
E. von Hippel-Lindau syndrome
Answer: B
QUESTION NO: 4
A 17-year-old boy, with short stature, obesity and neurobehavioural problems, was referred because of cold intolerance.
On examination, he and his mother had similar body habitus and short fingers (brachydactyly).
Investigations (before attending clinic):
serum sodium143 mmol/L (137-144) serum potassium4.4 mmol/L (3.5-4.9) serum creatinine93 umol/L (60-110) serum corrected calcium2.02 mmol/L (2.20-2.60) serum phosphate1.7 mmol/L (0.8-
1.4)
serum thyroid-stimulating hormone16.0 mU/L (0.4-5.0) serum free T410.0 pmol/L (10.0-22.0) plasma parathyroid hormone27.0 pmol/L (0.9-5.4)
His mother's blood tests were all normal.
What is the most likely diagnosis in this boy?
A. DiGeorge syndrome
B. McCune-Albright syndrome
C. polyglandular autoimmune syndrome type 1
D. pseudohypoparathyroidism
E. pseudopseudohypoparathyroidism
Answer: D
QUESTION NO: 5
A 72-year-old woman was referred for bone density assessment after sustaining a fracture of her right ankle after a minor fall. She had previously fractured her right wrist after tripping in the street. Her past medical history included occasional angina relieved by glyceryl trinitrate spray and a previous deep venous thrombosis. Her medication comprised aspirin, simvastatin, alendronic acid, and calcium and vitamin D, which she had been taking regularly for 2 years.
Investigations:
DXA scan of spine (L2-L4)T score -2.4
DXA scan of total hipT score -2.8
What is the most appropriate treatment?
A. continue alendronic acid
B. switch alendronic acid to pamidronate
C. switch alendronic acid to raloxifene
D. switch alendronic acid to strontium ranelate
E. switch alendronic acid to teriparatide
Answer: A
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Updated: May 27, 2022