MRCPUK SEND Exam Dumps - Actual Questions Answers

A 58-year-old man was referred to the endocrine clinic after a CT scan of abdomen had shown a 4.5-cm left adrenal mass, with a Hounsfield unit measurement of 11 (consistent with high lipid content). He had a 10-year history of type 2 diabetes mellitus and was taking metformin. He was also taking atenolol for hypertension.

On examination at the clinic, his blood pressure was 162/94 mmHg. He was centrally obese with a body mass index of 27 kg/m2 (18–25).

Investigations:

serum potassium3.9 mmol/L (3.5–4.9)

plasma renin activity (after 30 min upright)1.0 pmol/mL/h (3.0–4.3)

plasma aldosterone (after 4 h upright)680 pmol/L (330–830)

overnight dexamethasone suppression test (after 1 mg dexamethasone):

serum cortisol164 nmol/L (<50)

24-h urinary free cortisol132 nmol (55–250)

24-h urinary catecholamines

(adrenaline and noradrenaline)normal

As the lesion was >4 cm in diameter, laparoscopic adrenalectomy was recommended.

What is the most appropriate advice to give to the surgical team about perioperative management?

A 42-year-old motor mechanic was referred to the dermatologist with small cauliflower-like deposits on the points of his elbows. He was generally well, but on systemic enquiry, he described intermittent claudication. He had previously been hypertensive, and was taking thyroxine for primary hypothyroidism.

On examination, he was moderately obese. He had xanthelasmata on the upper eyelids of both eyes and tuberoeruptive xanthomata on both elbows, both knees and the nape of the neck.

Investigations:

serum alanine aminotransferase78 U/L (5–35)

fasting plasma glucose7.8 mmol/L (3.0–6.0)

serum urate0.48 mmol/L (0.23–0.46)

serum cholesterol13.4 mmol/L (<5.2)

serum LDL cholesterolnot measurable

serum HDL cholesterol0.90 mmol/L (>1.55)

fasting serum triglycerides9.32 mmol/L (0.45–1.69)

apolipoprotein E genotypehomozygous for apolipoprotein E2

What is the most likely diagnosis?

A 32-year-old man presented to the emergency department after becoming acutely unwell. He had a 5-year history of type 1 diabetes mellitus and no other significant medical history.

On examination, he was apyrexial, his pulse was 120 beats per minute, his blood pressure was 96/58 mmHg and his respiratory rate was 32 breaths per minute.

Investigations:

random plasma glucose14.2 mmol/L

arterial blood gases, breathing 60% oxygen:

PO28.9 kPa (11.3–12.6)

PCO22.6 kPa (4.7–6.0)

pH7.10 (7.35–7.45)

H+79 nmol/L (35–45)

bicarbonate6.1 mmol/L (21–29)

base excess–18 mmol/L (±2)

What diagnosis is most likely to account for these results?