A 27-year-old woman presents with recurrent headaches and sweating. On examination, a nodule is felt in the region of the thyroid gland. She mentions that her mother had kidney stones and died following a tumour in her neck. A surgeon recommends complete thyroidectomy as her treatment of choice.
What is the most important investigation to be done before the surgery?
A 28-year-old woman is evaluated in the endocrinology clinic for increased urine output. She weighs 60 kg and has a 24-hour urine output of 3500 ml. Her basal urine osmolality is 210 mOsm/kg.
She undergoes a fluid deprivation test and her urine osmolality after fluid deprivation (loss of weight 3 kg) is 350 mOsm/kg. Subsequent injection of subcutaneous DDAVP (desmopressin acetate) did not result in a further significant rise of urine osmolality after 2 hours (355 mOsm/kg).
Which of the following is the most likely diagnosis?
A 28-year-old woman is referred to the endocrinology clinic. She has been trying to conceive for the last 3 years without any success. Her prolactin level is 2600 mU/l (normal <360). The Endocrinologist arranges pituitary magnetic resonance imaging (MRI) that demonstrates a microprolactinoma. Which two of the following pharmacological agents may be appropriate treatment choices?
A 30-year-old lawyer presents with non-specific symptoms of tiredness.
Blood tests reveal normal thyroid function, cortisol, growth hormone and gonadotropins. Pituitary MRI reveals a 0.8cm microadenoma.
Which of the following represents the most appropriate course of action?
A 30-year-old man presented with polydipsia and polyuria for the last two years.
Investigations reveal:
Serum urea 9.5 mmol/L (2.5-7.5)
Serum creatinine 108 mol/L (60-110)
Serum corrected calcium 2.9 mmol/L (2.2-2.6)
Serum phosphate 0.7 mmol/L (0.8-1.4)
Plasma parathyroid hormone 6.5 pmol/L (0.9-5.4)
Which of the following is directly responsible for the increase in intestinal calcium absorption?
A 30-year-old man with type-1 diabetes mellitus on insulin presents in the A&E with fever, cough, vomiting and abdominal pain.
Examination reveals a dry mucosa, decreased skin turgor and a temperature of 37.8 °C.
Chest examination reveals bronchial breathing in the right lower lobe, and a chest X-ray shows it to be due to a right lower zone consolidation.
Other investigations show:
Blood glucose: 35 mmol/l
Na+: 132 mmol/l
K+: 5.5 mmol/l
urea: 8.0 mmol/l
creatinine: 120 μmol/l
pH: 7.15
HCO3: 12 mmol/l
p(CO2): 4.6 kPa
chloride: 106 mmol/l.
Urinary ketones are positive (+++).
The patient is admitted to the hospital and treated. Which of the following should not be used while treating him?
A 30-year-old woman is referred to endocrinology with thyrotoxicosis. Following a discussion of management options, she chooses to have radioiodine therapy. Which one of the following is the most likely adverse effect?
A 30-year-old woman presents with amenorrhoea and galactorrhoea. She has normal visual fields. You are concerned that she may have a prolactinoma.
Investigations were done and the results are as shown below:
Hb 12.5 g/dl
WCC 4.9 x109/l
PLT 199 x109/l
Na+ 140 mmol/l
K+ 4.9 mmol/l
Creatinine 90 ىmol/l
Prolactin 1150 mU/l
MRI shows a 7 mm pituitary microadenoma.
Which of the following hormones would you expect to be lower than normal?
A 30-year-old woman who works in a pharmacy comes to the clinic for review. Over the past few months, she has lost increasing amounts of weight and has become increasingly anxious about palpitations, which occur mostly at night. Her TSH is <0.1 IU/l (0.5-4.5).
On examination, her BP is 122/72 mmHg, her pulse is 92 and regular. You cannot palpate a goitre or any nodules on examination of her neck.
Which of the following investigations can differentiate between self-administration of thyroid hormone and endogenous causes of thyrotoxicosis?
A 32-year-old woman presents to the GP with tiredness and anxiety during the third trimester of her second pregnancy.
The Examination is unremarkable, with a BP of 110/70 mmHg and a pulse of 80. Her BMI is 24 and she has an abdomen consistent with a 31-week pregnancy. The GP decides to check some thyroid function tests.
Which of the following is considered to be normal?