MRCPUK SEND Exam With Confidence Using Practice Dumps

A 76-year-old man with a 17-year history of type 2 diabetes mellitus attended for his annual review. Comparison of his retinal screening report with the previous year’s report showed that his visual acuity was unchanged at 6/9 in both eyes. The previous year’s right eye retinal image had been reported as ‘pre-proliferative retinopathy’, whereas this year’s was reported as ‘pre-proliferative retinopathy with maculopathy’.

What is the most appropriate next step?

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?

A 47-year-old man presented with a 2-month history of polyuria and polydipsia. He awoke six times most nights to pass copious volumes of urine despite not drinking any fluid for 4 hours before going to bed.

Investigations:

MR scan of pituitary fossasee image

A water deprivation test confirmed the diagnosis of cranial diabetes insipidus.

What is the most likely underlying diagnosis?