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What is the most appropriate initial management of the adrenal lesion?
A 55-year-old woman presented complaining of difficulty losing weight. On examination, her blood pressure was 170/105 mmHg and urinalysis showed protein 1+. An ultrasound scan of abdomen revealed a 4.5-cm solid lesion in the right adrenal gland. She was treated with ramipril and further endocrine evaluation was performed. Investigations: serum...
After what minimum interval would it be safe for her to conceive again?
A 32-year-old woman with a recurrent history of Graves’ thyrotoxicosis was being considered for radioiodine treatment. However, she wanted to conceive again at some stage and asked how soon she could become pregnant. After what minimum interval would it be safe for her to conceive again?A . 2 monthsB ....
What is the most appropriate next step in management?
A 64-year-old man presented with palpitations, fatigue and malaise. Two months previously, he had sustained an acute myocardial infarction complicated by ventricular tachycardia and cardiac arrest, and had been discharged taking amiodarone 200 mg daily. On examination, he appeared well, his pulse was 90 beats per minute and regular, and...
What is the most likely diagnosis?
A 16-year-old boy was referred to the diabetes clinic following the discovery of a random plasma glucose concentration of 18.0 mmol/L. His general practitioner had begun treatment with metformin. The patient had a body mass index of 35 kg/m2 (18C25). He had had problems throughout his childhood, and had been...
The use of what hypoglycaemic therapy is acceptable in this situation?
A 25-year-old woman presented at 28 weeks’ gestation after a screening 75-g oral glucose tolerance test, which had shown a fasting plasma glucose of 5.6 mmol/L (3.0C6.0) and a 2-h plasma glucose of 9.8 mmol/L (<7.8). She had a family history of type 2 diabetes mellitus and a pre-pregnancy body...
What is the most appropriate next step in management?
A 26-year-old man presented urgently, complaining of muscle pains. He had been found to have heterozygous familial hypercholesterolaemia 2 years previously owing to a mutation in the PCSK9 gene. He had a strong family history of premature vascular disease. He was taking atorvastatin 80 mg daily. Investigations: serum creatine kinase2782...
What additional medication is most appropriate?
A 64-year-old man was reviewed in the diabetes clinic. He had a history of type 2 diabetes mellitus treated for 12 years. He had sustained a previous episode of acute kidney injury believed to be secondary to renal artery stenosis and exposure to an ACE inhibitor. He was being treated...
What is the most appropriate next step in management?
An 80-year-old man was referred because of weight gain and low mood but said he was otherwise well. He had a complex cardiac history including a ventricular fibrillation arrest and a permanent pacemaker, but he had been very well for the past 3 years. He was taking amiodarone 100 mg...
What does carbimazole inhibit?
Carbimazole is routinely used in the management of thyroid disease. What does carbimazole inhibit?A . deiodinase type 1B . presentation of thyroid antigens to autoreactive T cellsC . sodium/iodide symporterD . thyroglobulin synthesisE . thyroid peroxidaseView AnswerAnswer: E
What is the most likely cause of her diabetes?
A 33-year-old woman was seen for diabetes review 2 months after her first pregnancy. Diabetes mellitus had been diagnosed at 18 weeks’ gestation. She had experienced no symptoms; routine urinalysis had shown glucose 4+, with no ketones, and her fasting blood glucose concentration was 6.2 mmol/L (3.0C6.0), rising to 13.5...