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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 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: 3
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: 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 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
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Updated: May 27, 2022