MRCPUK SEND Exam With Confidence Using Practice Dumps

A 55-year-old woman presented with a 3-week history of nausea and vomiting. Her only medical complaints were frequent dyspepsia, for which she was taking indigestion tablets, and asthma for which she was taking a salbutamol inhaler as required.

On examination, there was no evidence of lymphadenopathy, her chest was clear on auscultation and abdominal examination was normal.

Investigations (before and after taking omeprazole for 3 weeks):

beforeafternormal

erythrocyte sedimentation rate (mm/1st h)44<30

serum creatinine (µmol/L)17011060–110

serum corrected calcium (mmol/L)2.852.402.20–2.60

serum phosphate (mmol/L)1.90.8–1.4

serum angiotensin-converting enzyme (U/L)8525–82

plasma parathyroid hormone (pmol/L)0.44.40.9–5.4

What is the most likely cause of the hypercalcaemia?

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?