Of /Endocrinology&Metabolic Medicine
Total Page：16
File Type：pdf, Size：1020Kb
Log Out Welcome gehad Home Online Revision Courses Books Help Contact Us About Us Blog My Account Online Extras Community FAQs You are here: MyPasTest » MRCP 2 Online - Apr Exam 2014 » Question Question Browser: MRCP 2 Session Progress Q Correct 60 Q Incorrect 256 Q Total 316 Average Q Percentage 18 % A 37-year-old woman has been brought to A&E with a 1-day history of abdominal pain, diarrhoea and vomiting. She has a history of type-1 diabetes mellitus and pernicious anaemia. Her partner tells you that her GP has R Correct 60 recently prescribed amoxicillin for her chest infection and that she has lost 12.5 kg (nearly 2 stone) in weight over R Incorrect 256 the last few months. She does not smoke or drink alcohol. On examination, she is flushed, disorientated, agitated R Total 316 and jaundiced. Her temperature is 42.1 °C, pulse 180 bpm and irregular and BP 180/70 mmHg. You detect a third R Percentage 18 heartsound, her chest is clear and her abdomen generally tender. Her legs are weak proximally and all reflexes % brisk. She has some pitting oedema of her lower limbs. View More Blood tests reveal: Key: Difficulty Levels Na 131 mmol/l K 2.8 mmol/l urea 17.6 mmol/l creatinine 165 µmol/l Ca 2.82 mmol/l Easy Average Difficult bilirubin 64 µ mol/l Correct Incorrect ALT 141 U/l alkaline phosphatase 210 U/l glucose 19.8 mmol/l Reference WBC 17.2 × 109/l neutrophils 15.6 × 109/l Show Normal Values Hb 10.3 g/dl Haematology MCV 102.4 fl Haemoglobin platelets 273 × 109 /l Males 13.5 - Results of an ECG show a fast AF. 17.5 g/dl What is the most likely diagnosis? Females 11.5 - 15.5 Atypical pneumonia g/dl Diabetic ketoacidosis MCV 76 - 98 Thyroid storm fl Gastroenteritis Haematocrit 0 35 Immunoglobulins Adverse drug reaction IgM 0.5 - 2.0 2292 g/l Log Out Welcome gehad Home Online Revision Courses Books Help Contact Us About Us Blog My Account Online Extras Community FAQs You are here: MyPasTest » MRCP 2 Online - Apr Exam 2014 » Question Question Browser: MRCP 2 Session Progress Q Correct 60 Q Incorrect 257 Q Total 317 Average Q Percentage 18 % R Correct 60 R Incorrect 257 A 37-year-old woman has been brought to A&E with a 1-day history of abdominal pain, diarrhoea and vomiting. R Total 317 She has a history of type-1 diabetes mellitus and pernicious anaemia. Her partner tells you that her GP has R Percentage 18 recently prescribed amoxicillin for her chest infection and that she has lost 12.5 kg (nearly 2 stone) in weight over % the last few months. She does not smoke or drink alcohol. On examination, she is flushed, disorientated, agitated and jaundiced. Her temperature is 42.1 °C, pulse 180 bpm and irregular and BP 180/70 mmHg. You detect a third View More heartsound, her chest is clear and her abdomen generally tender. Her legs are weak proximally and all reflexes brisk. She has some pitting oedema of her lower limbs. Blood tests reveal: Peer Responses Na 131 mmol/l K 2.8 mmol/l urea 17.6 mmol/l creatinine 165 µmol/l Key: Difficulty Levels Ca 2.82 mmol/l bilirubin 64 µ mol/l ALT 141 U/l alkaline phosphatase 210 U/l Easy Average Difficult glucose 19.8 mmol/l WBC 17.2 × 109/l Correct Incorrect neutrophils 15.6 × 109/l Hb 10.3 g/dl Reference MCV 102.4 fl 9 platelets 273 × 10 /l Show Normal Values Results of an ECG show a fast AF. Haematology What is the most likely diagnosis? Haemoglobin Males 13.5 - Atypical pneumonia « YOUR ANSWER 17.5 Diabetic ketoacidosis g/dl Thyroid storm « CORRECT ANSWER Females 11.5 - 15.5 Gastroenteritis g/dl Adverse drug reaction MCV 76 - 98 fl YOUR ANSWER WAS INCORRECT Haematocrit 0 35 Immunoglobulins The Answer Comment on this Question IgM 0.5 - 2.0 g/l IgG 5 - 16 g/l Her past history of diabetes mellitus and pernicious anaemia make it more likely that she has a further autoimmune disorder. The history of weight loss suggests an underlying thyroid disorder, with the thyroid IgA 1.0 - 4.0 g/l storm being precipitated by her chest infection. Biochemistry Thyroid storm is a sudden, life-threatening exacerbation of thyrotoxicosis. Some series suggest a mortality rate of between 30 and 75%. Its manifestations are due to the action of excess thyroid hormone. Fever is the Na+ 135 - most characteristic feature, with the temperature often rising above 41°C. There may be evidence of organ 145 damage. The clinical picture is frequently clouded by a secondary infection such as pneumonia or a viral mmol/l infection. Death may be caused by cardiac arrhythmia, congestive heart failure, hyperthermia or other K+ 3.5 - unidentified factors. 5.0 mmol/l The diagnosis of thyroid storm is made entirely on clinical grounds. The results of thyroid function tests will rarely be available soon enough to make the diagnosis. Urea 2.5 - 6.5 mmol/l Propylthiouracil followed by a stable iodine preparation (eg Lugol’s iodine) is usually given. Propranolol, intravenous fluids, dexamethasone and cooling are also often required. Finally, one must remember to treat Creatinine 50 - the precipitating cause. 120 Diabetes Glucose 2292 Random 3.5 - 5.5 mmol/l* Fasting <7 mmol/l/ Hb A1c <7.0% Average *If >5.5 mmol/l, then OGTT at 2 hours: Endocrinology TSH 0.17 - 3.2 µU/l fT 11 - 22 4 pmol/l fT 3 3.5 - 5 pmol/l Cortisol 9 am 140 - 500 Blood gases pH 7.35 - 7.45 PaCO2 4.6 - 6.0 kPa PaO2 10.5 - 13.5 kPa - Log Out Welcome gehad Home Online Revision Courses Books Help Contact Us About Us Blog My Account Online Extras Community FAQs You are here: MyPasTest » MRCP 2 Online - Apr Exam 2014 » Question Question Browser: MRCP 2 Session Progress Q Correct 60 Q Incorrect 257 Q Total 317 Average Q Percentage 18 % A 54-year-old housewife is referred to your clinic with a history of funny turns over the last 2 years. She complains of intermittent episodes of feeling sweaty and faint and having double vision. She tells you that she R Correct 60 often feels better after a strong cup of tea with three sugars. She has no medical history of note and is taking no R Incorrect 257 tablets. Her mother had diabetes mellitus and her father had epilepsy. She smokes 10 cigarettes a day and drinks R Total 317 alcohol occasionally. Her examination is completely normal. R Percentage 18 % Results of blood tests show: View More Na 136 mmol/l K 5.4 mmol/l Key: Difficulty Levels urea 6.8 mmol/l creatinine 84 mmol/l Ca 2.93 mmol/l PO4 0.84 mmol/l Easy Average Difficult glucose 5.3 mmol/l Correct Incorrect What is the most likely diagnosis? Petit mal epilepsy Reference Recurrent TIAs Multiple endocrine neoplasia type-1 Show Normal Values Paroxysmal atrial fibrillation Haematology Phaeochromocytoma Haemoglobin Males 13.5 - 2293 17.5 g/dl Females 11.5 - 15.5 g/dl MCV 76 - 98 Average fl Haematocrit 0 35 Immunoglobulins IgM 0.5 - 2.0 g/l Log Out Welcome gehad Home Online Revision Courses Books Help Contact Us About Us Blog My Account Online Extras Community FAQs You are here: MyPasTest » MRCP 2 Online - Apr Exam 2014 » Question Question Browser: MRCP 2 Session Progress Q Correct 60 Q Incorrect 258 Q Total 318 Average Q Percentage 18 % R Correct 60 R Incorrect 258 A 54-year-old housewife is referred to your clinic with a history of funny turns over the last 2 years. She R Total 318 complains of intermittent episodes of feeling sweaty and faint and having double vision. She tells you that she R Percentage 18 often feels better after a strong cup of tea with three sugars. She has no medical history of note and is taking no % tablets. Her mother had diabetes mellitus and her father had epilepsy. She smokes 10 cigarettes a day and drinks alcohol occasionally. Her examination is completely normal. View More Results of blood tests show: Peer Responses Na 136 mmol/l K 5.4 mmol/l urea 6.8 mmol/l creatinine 84 mmol/l Ca 2.93 mmol/l PO4 0.84 mmol/l Key: Difficulty Levels glucose 5.3 mmol/l What is the most likely diagnosis? Petit mal epilepsy « YOUR ANSWER Easy Average Difficult Recurrent TIAs Correct Incorrect Multiple endocrine neoplasia type-1 « CORRECT ANSWER Paroxysmal atrial fibrillation Reference Phaeochromocytoma Show Normal Values YOUR ANSWER WAS INCORRECT Haematology Haemoglobin The Answer Comment on this Question Males 13.5 - 17.5 g/dl An insulinoma should be suspected in this patient, given her 2-year history of funny turns and the fact that Females she feels better after a strong cup of tea. Furthermore, the blood tests reveal an elevated calcium, raising the 11.5 - 15.5 suspicion of associated hyperparathyroidism. Multiple endocrine neoplasia (MEN) 1 should be suspected g/dl here, which may be a combination of a pituitary tumour (often a macroadenoma), hyperparathyroidism and a pancreatic islet tumour.Of course all these conditions may not necessarily occur at the same point in time. MCV 76 - 98 fl The MEN 1 gene has an autosomal-dominant pattern of inheritance. Any individual with a relative with MEN 1 should be screened. Mutational analysis of the coding region has a sensitivity of about 95% in MEN 1 Haematocrit 0 35 Immunoglobulins patients.