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Question 1 of 35
1. Question1 point(s)
Which of the following medication are generally considered safe when used as monotherapy in patients at risk of hypoglycaemia (e.g. lorry drivers)?CorrectIncorrect
Question 2 of 35
2. Question1 point(s)
Which of the following would you expect to find in a patient with Conn’s syndrome?CorrectIncorrect
Question 3 of 35
3. Question1 point(s)
A 54 year old previously healthy man presents with tiredness, worsening over the past 2 months. On examination you note abdominal striae, central obesity, a round, pale face and wasted proximal muscles. You arrange a dexamethasone suppression test. The patient has no suppression of cortisol with 1mg of dexamethasone, and 8mg of dexamethasone is unable to suppress his cortisol but does suppress ACTH levels.
What is the most likely diagnosis?CorrectIncorrect
Question 4 of 35
4. Question1 point(s)
Which of the following is NOT an effect of cortisol?CorrectIncorrect
Question 5 of 35
5. Question1 point(s)
What hormone, secreted from the anterior pituitary stimulates the adrenal gland to produce cortisol?CorrectIncorrect
Question 6 of 35
6. Question1 point(s)
What is the underlying pathology in Cushing’s disease?CorrectIncorrect
Question 7 of 35
7. Question1 point(s)
What is the most appropriate investigation to confirm the diagnosis in a patient who presents with symptoms of Cushing’s syndrome?CorrectIncorrect
Question 8 of 35
8. Question1 point(s)
A 57 year old lifelong smoker presents with a 3 month history of worsening unintentional 3 stone weight loss, haemoptysis and fatigue. On examination she has central obesity, abdominal striae, muscle wasting and a “buffalo hump”.
Based on the limited information provided, what is the most likely diagnosis?CorrectIncorrect
Question 9 of 35
9. Question1 point(s)
A 32 year old otherwise fit and well female patient is bought into hospital by her roommate, who found it difficult to wake her up in the morning. Over the last few hours she has become increasingly more confused and drowsy, and was feeling faint.
On examination she has a GCS of 12 and is confused. Her blood pressure is 81/45, heart rate 68, respiratory rate 12, temperature 35.9C and oxygen saturations of 98% on room air.
Her blood tests reveal the following abnormalities:
- Glucose 3.2
- Sodium 129
- Potassium 5.4
- CRP 3.4
Other than correcting her hypoglycaemia and administering IV fluids, what is the most appropriate immediate management?CorrectIncorrect
Question 10 of 35
10. Question1 point(s)
A 45 year old with known primary adrenal failure presents to her GP with a 3 day history of a dry cough, sore throat, muscles aches and a blocked nose.
Examination reveals evidence of the symptoms above, however she is apyrexial and her chest is clear.
What is the most appropriate management?CorrectIncorrect
Question 11 of 35
11. Question1 point(s)
Match the hormone to the correct statement.
- Has a half-life of 7 days
- The active form of thyroid hormone
- Stimulates the pituitary gland
- Is high in Hashimoto's thyroiditis
- Produced by the posterior pituitary
- Specifically targets the adrenal glands
- Produced by the adrenal glands
- Inhibit the secretion of glucagon
- Indirectly reduce secretion of insulin
Anti-diuretic hormone (ADH)
Question 12 of 35
12. Question1 point(s)
What condition is associated with TSH receptor antibodies?CorrectIncorrect
Question 13 of 35
13. Question1 point(s)
A 56 year old lady presents with anxiety, goitre and bilateral exopthalmos.
What is the most likely diagnosis based on this limited information?CorrectIncorrect
Question 14 of 35
14. Question1 point(s)
A 64 year old woman with hypothyroidisim presents for her routine annual review. Her blood test one week ago reveals a TSH of 0.2 mIU/l (normal range 0.4 to 4.0).
She is currently on 150 mcg once daily of levothyroxine.
What is the most appropriate next step in management?CorrectIncorrect
Question 15 of 35
15. Question1 point(s)
Match the term to the correct statement
- The conversion of protein into glucose
- The conversion of glycogen into glucose
- The conversion of fatty acids into ketone bodies
- Produced in the alpha cells in the Islets of Langerhans
- Directly stimulates muscle cells to use glucose as fuel
- Directly stimulates secretion by the beta cells in the Islets of Langerhans
- Specifically inhibited by sitagliptin
Question 16 of 35
16. Question1 point(s)
In what disease could you find pretibial myxoedema?CorrectIncorrect
Question 17 of 35
17. Question1 point(s)
A 34 year old man presents with tachycardia, fever, and neck soreness. He has been feeling run down with muscle aches and lethargy for the past 5 days. He is normally fit and well.
On examination he has tenderness over his thyroid gland.
Blood tests reveal a suppressed (low) TSH and a raised T3 and T4.
What is the most likely diagnosis?CorrectIncorrect
Question 18 of 35
18. Question1 point(s)
A 75 year old patient is diagnosed with Grave’s disease.
She otherwise lives a normal and health life and is enjoying spending time with two new grandchildren. She is on medication for hypercholesterolemia and hypertension but is otherwise well.
What would be the most appropriate treatment for her Grave’s disease?CorrectIncorrect
Question 19 of 35
19. Question1 point(s)
A 44 year old lady presents complaining of chronic fatigue and general tiredness. She has also noticed her hair and skin becoming more dry and is worried she might be loosing her hair.
On examination her thyroid gland is barely palpable
Her blood tests reveal a TSH of 13 (normal range 0.5 – 4.0 mIU/L) and free T4 of 1.1 (normal range 4.5 to 11.2 mcg/dL).
What is her most likely diagnosis?CorrectIncorrect
Question 20 of 35
20. Question1 point(s)
When treating a patient who is in DKA with a fixed rate insulin infusion, what is the most important thing to add to the fluid infusion?CorrectIncorrect
Question 21 of 35
21. Question1 point(s)
What is the cutoff for a HbA1C level indicating a diagnosis of Type 2 Diabetes?CorrectIncorrect
Question 22 of 35
22. Question1 point(s)
Match the diagnosis to the blood results.
- Insufficient for any diagnosis
- Impaired fasting glucose
- Impaired glucose tolerance
- Type 2 Diabetes
Random blood glucose 9.6 mmol/l
HbA1c 39 mmol/mol
Fasting glucose 6.4 mmol/l and oral glucose tolerance test 7.3 mmol/l at 2 hours
Fasting glucose 5.9 mmol/l and oral glucose tolerance test 7.9 mmol/l at 2 hours
Fasting glucose 7.0 mmol/l and oral glucose tolerance test 11.2 mmol/l at 2 hours
Question 23 of 35
23. Question1 point(s)
A 41 year old man is diagnosed with acromegaly secondary to a large pituitary adenoma.
What visual field defect would you expect he might have?CorrectIncorrect
Question 24 of 35
24. Question1 point(s)
Which one of the following medications is considered a somatostatin analogue?CorrectIncorrect
Question 25 of 35
25. Question1 point(s)
What type of cells secrete parathyroid hormone?CorrectIncorrect
Question 26 of 35
26. Question1 point(s)
What type of cells, found in the pancreas, secrete glucagon?CorrectIncorrect
Question 27 of 35
27. Question1 point(s)
A 19 year old man presents with polyuria, polydipsia, vomiting and exhaustion.
On examination he has reduced skin turgor, dry mouth and sunken eyes, and a sweet acetone smell to his breath.
His blood pressure is 94/67, heart rate 106, respiratory rate 19, temperature 36.7C and oxygen saturation of 99% on room air.
While waiting for laboratory blood tests and an ABG to come back, the emergency department nurse checks his capillary blood glucose on a bedside device. The result simply says “high”, and is unrecordable.
What is the most appropriate initial management whilst awaiting further results?CorrectIncorrect
Question 28 of 35
28. Question1 point(s)
Which of the following has the greatest inhibitory affect on growth hormone?CorrectIncorrect
Question 29 of 35
29. Question1 point(s)
What is Conn’s Syndrome?CorrectIncorrect
Question 30 of 35
30. Question1 point(s)
Which one of the following medication acts as an aldosterone antagonist?CorrectIncorrect
Question 31 of 35
31. Question1 point(s)
What electrolyte disturbance would make you consider a diagnosis of SIADH?CorrectIncorrect
Question 32 of 35
32. Question1 point(s)
An 87 year old man is post op after a total hip replacement following a fractured neck of femur. He is found to have hyponatraemia that is stable around 120 mmol/l.
This is causing postural hypotension, muscle cramps and occasional mild confusion.
He is euvolaemic, has a urinary sodium concentration of 75 mmol/l, and has normal thyroid function, chest xray and short synacthen tests.
Fluid restriction achieves a slight rise in serum sodium to 125 mmol/l.
What is the next most appropriate option for treating the cause of his hyponatraemia.CorrectIncorrect
Question 33 of 35
33. Question1 point(s)
A 45 year old, normally fit and well lady presents with polyuria and polydipsia. On examination she appears dehydrated. Her blood sugar and other blood tests are normal.
What is the most appropriate next step in investigating this patient?CorrectIncorrect
Question 34 of 35
34. Question1 point(s)
What type of cells produce adrenalin in the adrenal glands?CorrectIncorrect
Question 35 of 35
35. Question1 point(s)
A 57 year old man presents with fluctuating symptoms of intense anxiety, sweating, palpitations and headache. These can last half and hour and happen several times a day. They have been getting worse over the last 2 months.
What would be the most appropriate investigation given the suspected diagnosis?CorrectIncorrect