MRCPUK SEND Exam With Confidence Using Practice Dumps

A 56-year-old man presented with a 6-month history of erectile dysfunction. He had noticed a gradual reduction in his frequency of shaving from daily to twice a week. His libido had diminished and he felt that he was not as strong as he once was. He also described general aches and pains. He was a farm worker and had drunk a bottle of vodka daily for several years, but had stopped drinking 2 years previously. He was a non-smoker.

Investigations:

serum urea6.2 mmol/L (2.5–7.0)

serum creatinine89 µmol/L (60–110)

serum albumin40 g/L (37–49)

serum total bilirubin17 µmol/L (1–22)

serum alanine aminotransferase48 U/L (5–35)

serum aspartate aminotransferase37 U/L (1–31)

haemoglobin A1c55 mmol/mol (20–42)

serum cortisol (09.00 h)389 nmol/L (200–700)

serum testosterone0.7 nmol/L (9.0–35.0)

plasma follicle-stimulating hormone2.1 U/L (1.0–7.0)

plasma luteinising hormone2.4 U/L (1.0–10.0)

serum prolactin458 mU/L (<360)

serum thyroid-stimulating hormone3.4 mU/L (0.4–5.0)

MR scan of pituitarysee image

What is the most likely explanation of his symptoms?

An 18-year-old man with cystic fibrosis was referred to clinic. Over recent months his lung function had deteriorated and he had lost weight. He was being treated for a chest infection at the time of the consultation.

Investigations:

oral glucose tolerance test (75 g):

fasting plasma glucose8.2 mmol/L (3.0–6.0)

2-h plasma glucose13.5 mmol/L (<7.8)

What is the most appropriate management?

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?