MRCPUK SEND Exam With Confidence Using Practice Dumps

A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin’s lymphoma at the age of 17.

What is the most appropriate investigation?

A 66-year-old woman was admitted with carpopedal spasm. During the previous week she had had 2 days of diarrhoea following treatment with ciprofloxacin for a urinary tract infection. She had long-standing rheumatoid arthritis treated with prednisolone 5 mg daily, and was also taking alendronic acid, omeprazole and furosemide.

Investigations:

serum creatinine115 ?mol/L (60–110)

serum corrected calcium1.79 mmol/L (2.20–2.60)

serum alkaline phosphatase124 U/L (45–105)

serum magnesium0.26 mmol/L (0.75–1.05)

plasma parathyroid hormone2.7 pmol/L (0.9–5.4)

Which medicine is most likely to be responsible for her metabolic derangement?

A 45-year-old man had type 2 diabetes mellitus of 2 years’ duration. He had no history of ischaemic heart disease or microvascular complications, and was euthyroid. There was no family history of ischaemic heart disease. He was a non-smoker and drank 4 to 8 units of alcohol per week. He was taking metformin only.

On examination, his blood pressure was 120/78 mmHg and his body mass index was 24 kg/m2 (18–25).

His calculated 10-year cardiovascular risk was 8.5%.

Investigations (fasting):

serum sodium142 mmol/L (137–144)

serum potassium3.8 mmol/L (3.5–4.9)

serum creatinine90 µmol/L (60–110)

haemoglobin A1c48 mmol/L (20–42)

urinary albumin:creatinine ratio1.5 mg/mmol (<2.5)

serum cholesterol5.1 mmol/L (<5.2)

serum HDL cholesterol1.50 mmol/L (>1.55)

fasting serum triglycerides1.22 mmol/L (0.45–1.69)

What does the NICE guidance (CG181, July 2014) on type 2 diabetes mellitus recommend as the most appropriate next step in management?