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1. A 26-year-old woman presented with recurrent Graves' disease. After discussing the treatment options, she chose radioiodine.
What dose of radioiodine is most appropriate in uncomplicated Graves' disease?
A) 400-600 MBq
B) 100-200 MBq
C) 1400-1600 MBq
D) 1000-1200 MBq
E) 700-900 MBq
2. A 27-year-old woman with type 1 diabetes mellitus was invited to attend a structured education (e.g. DAFNE) coursE.
Which quality of life domain is most affected when a person is found to have type 1 diabetes mellitus?
A) family life
B) working life and work-related opportunities
C) sex life
D) enjoyment of leisure activities
E) freedom to eat as one wishes
3. 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) switch alendronic acid to pamidronate
B) switch alendronic acid to teriparatide
C) switch alendronic acid to strontium ranelate
D) continue alendronic acid
E) switch alendronic acid to raloxifene
4. A 78-year-old man presented with confusion, lethargy and thirst. He had hypertension treated with lisinopril 20 mg daily.
On examination, he was dehydrated. His pulse was 110 beats per minute and his blood pressure was 84/40 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium155 mmol/L (137-144) serum potassium5.2 mmol/L (3.5-4.9) serum bicarbonate17 mmol/L (20-28) serum urea40.0 mmol/L (2.5-7.0)
serum creatinine358 umol/L (60-110) random plasma glucose78.0 mmol/L He was treated with sodium chloride 0.9%. After 8 hours' treatment, his urine output was
10 mL/h and his blood pressure was 121/50 mmHg. Investigations (after 8 hours' treatment): serum sodium151 mmol/L (137-144)
serum potassium4.9 mmol/L (3.5-4.9) serum bicarbonate18 mmol/L (20-28) serum urea39.0 mmol/L (2.5-7.0) serum creatinine347 umol/L (60-110)
random plasma glucose48.0 mmol/L
What is the most appropriate next step in management?
A) compound lactate solution (Hartmann's solution)
B) sodium chloride 0.9%
C) sodium chloride 0.45%
D) sodium chloride 0.18% and glucose 4%
E) sodium chloride 0.18% and glucose 5%
5. A 62-year-old woman was referred with difficulty in swallowing and a painful, swollen neck.
On examination, her neck was tender to palpation with a small, diffuse goitre. There was no
associated neck lymphadenopathy.
Investigations:
serum thyroid-stimulating hormone<0.04 mU/L (0.4-5.0)
serum free T426.0 pmol/L (10.0-22.0)
serum free T312.0 pmol/L (3.0-7.0)
What is the most likely diagnosis?
A) thyroid carcinoma
B) Graves' disease
C) haemorrhage into a thyroid cyst
D) toxic adenoma
E) subacute thyroiditis
Solutions:
Question # 1 Answer: A | Question # 2 Answer: E | Question # 3 Answer: D | Question # 4 Answer: B | Question # 5 Answer: E |
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