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QUESTION NO: 1
An 18-year-old woman presented with a 2-month history of polyuria and polydipsia. She had been previously fit and well with regular periods. She was not taking any contraception.
Investigations:
serum potassium5.2 mmol/L (3.5-4.9)
serum corrected calcium2.30 mmol/L (2.20-2.60)
serum cortisol (09.00 h)350 nmol/L (200-700)
She went on to have a water deprivation test, the results of which are detailed below.
time (h)serum osmolality (mosmol/kg)urine osmolality (mosmol/kg) normal: 278-300normal: 100-
1000 08.3028952 11.3029282 14.30301153 15.30-172
She was then given intramuscular DDAVP@ 2 micrograms at 16.00 h.
time (h)serum osmolality (mosmol/kg)urine osmolality (mosmol/kg) normal: 278-300normal: 100-
1000 16.3030017.30-530 18.30-532
Results from an MR scan of pituitary are shown (see image).
What is the most likely diagnosis?
A. autoimmune (lymphocytic) hypophysitis
B. craniopharyngioma
C. non-functioning pituitary adenoma
D. psychogenic polydipsia
E. Rathke's cleft cyst
Answer: A
QUESTION NO: 2
A 33-year-old woman was reviewed in the insulin pump clinic. She had had type 1 diabetes mellitus for 10 years. She had been treated with a continuous subcutaneous insulin infusion 3 years previously, because of frequent hypoglycaemic episodes. She had recently undergone continuous glucose monitoring (see image).
Investigations:
haemoglobin A1c43 mmol/mol (20-42)
What is the most likely cause of the blood glucose trace seen between 08.00 h and 10.00 h?
A. blocked infusion set
B. dawn phenomenon
C. inadequate basal insulin rate
D. inadequate mealtime insulin bolus
E. overcorrection of hypoglycaemia
Answer: D
QUESTION NO: 3
A 37-year-old man, who had previously undergone female-to-male gender reassignment surgery, attended the endocrine clinic for annual review. He had no complaints and was happy with the results of his treatment. His medication consisted of testosterone undecanoate 1 g intramuscularly every 3 months.
What variable is it most important to monitor?
A. fasting plasma glucose
B. haematocrit
C. serum luteinising hormone
D. serum prostate-specific antigen
E. serum testosterone
Answer: B
QUESTION NO: 4
A 32-year-old woman with a recurrent history of Graves' thyrotoxicosis was being considered for radioiodine treatment. However, she wanted to conceive again at some stage and asked how soon she could become pregnant.
After what minimum interval would it be safe for her to conceive again?
A. 2 months
B. 4 months
C. 6 months
D. 8 months
E. 12 months
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