MRCPUK SEND Exam With Confidence Using Practice Dumps

A 17-year-old girl was referred to the transition clinic. She was taking hydrocortisone 10 mg twice daily and fludrocortisone 150 micrograms daily following a failed short tetracosactide (Synacthen®) test 5years previously. She had entered puberty at the age of 10 but had never achieved adult breast development or menarche.

Investigations:

haemoglobin95 g/L (115–165)

MCV124 fL (80–96)

white cell count8.4 ? 109/L (4.0–11.0)

platelet count334 ? 109/L (150–400)

serum sodium138 mmol/L (137–144)

serum potassium4.4 mmol/L (3.5–4.9)

serum urea3.5 mmol/L (2.5–7.0)

serum corrected calcium1.80 mmol/L (2.20–2.60)

serum follicle-stimulating hormone67.9 U/L (2.5–10.0)

serum luteinising hormone56.4 U/L (2.5–10.0)

What is the most likely diagnosis?

A pregnant 36-year-old woman presented to the diabetes outpatient clinic. She had type 2 diabetes mellitus treated with diet, lifestyle changes and metformin 500 mg twice daily.

On examination, her blood pressure was 128/84 mmHg.

Investigations:

haemoglobin A1c47 mmol/mol (20–42)

urinary albumin:creatinine ratio1.6 mg/mmol (<3.5)

Which is the best agent to reduce the risk of pre-eclampsia in this patient?

A 33-year-old woman, who was 9 weeks into her first pregnancy, was admitted with prolonged vomiting and secondary dehydration. She had lost 6 kg in weight since becoming pregnant. There was a strong family history of thyroid disease: two sisters were hypothyroid and one brother had required radioactive iodine for Graves’ disease.

On examination, she had a smooth, small goitre. Her pulse was 94 beats per minute and her blood pressure was 104/42 mmHg. There was a tremor of the outstretched hands. Urinalysis was normal.

Investigations:

serum sodium143 mmol/L (137–144)

serum potassium4.4 mmol/L (3.5–4.9)

serum creatinine105 µmol/L (60–110)

serum thyroid-stimulating hormone (TSH)<0.01 mU/L (0.4–5.0)

serum free T424.0 pmol/L (10.0–22.0)

serum free T311.0 pmol/L (3.0–7.0)

A TSH receptor antibody concentration was awaited.

In addition to rehydration, what is the most appropriate next step in the management of her abnormal thyroid function?