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QUESTION NO: 1
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
QUESTION NO: 2
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: 3
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: 4
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: 5
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
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Updated: May 27, 2022