PRACTISE EXAM QUESTIONS (EFA) Flashcards
A 35 year old woman, with primary hypothyroidism diagnosed 13 years ago, complains of feeling exhausted for several months. She also complains of weight loss and dizziness. Blood pressure in clinic is 110/80 mmHg lying and 90/70 mmHg standing. Blood tests show: Sodium 128 mmol/L (133 – 146) Potassium 5.5 mmol/L (3.5 – 5.3) fT4 18 pmol/L (9 - 23) TSH 3.9 mU/L (0.3 – 4.2) What is the next step in her management?
A Increase her thyroxine dose
B Measure 9AM cortisol and ACTH
C Measure a full blood count
D Measure plasma osmolality
E Reduce her thyroxine dose
B: measure 9AM cortisol and ACTH
At his annual diabetes review, 55 year old man with a 10 year history of well controlled type 2 diabetes mellitus complains of erectile dysfunction. He takes metformin only. His GP checks some bloods. HbA1c 48 mmol/mol (20-41) Testosterone 3 nmol/L (10-20) Prolactin 25 000 IU/mL (45-375) FSH 0.1 mIU/mL (1.6-11) LH 0.2 mIU/mL (1.3-8) What should the GP do next?
A Anterior Pituitary MRI
B Counsel him that erectile dysfunction is common in type 2 diabetes mellitus
C Intensify his glycaemic control
D Perform a testicular examination
E Repeat the blood tests at a different time of day
A: anterior pituitary MRI
A 65 year old woman presents to the Accident and Emergency department with vomiting and constipation.She has a previous history of lung cancer which was treated by surgery and chemotherapy 1 year ago. On examination, she looks dehydrated. Routine biochemistry shows:
normal renal function,
calcium 2.90 (reference range 2.15-2.60 mmol/L), phosphate 0.90 (reference range 0.80-1.40 mmol/L),
25 hydroxyvitamin D 60 (reference range 70-150 mmol/L), PTH <0.1 (reference range 1.1-6.8 mmol/L).
Abdominal x ray is normal.
What treatment should she receive next?
IV fluids
A 34 year old woman presents to her GP with weight loss and palpitations. Her GP checks some thyroid function tests:
fT4 32 pmol/L (9 - 23)
fT3 13 pmol/L (3.1 – 6.8)
TSH <0.01 mU/L (0.3 – 4.2)
Prior to this, she has been fit and well, with no medical problems and is not taking any medications. What 2 medications should the GP start?
Non-selective beta blocker AND anti-thyroid drug
