A general practitioner wanted to discuss a rejected TSH request for one of his patients. The patient is a 40 year old woman, who is clinically euthyroid and has no history of thyroid disease. She last had blood tests 8 months earlier, at which time thyroid function was normal. What is the minimum retesting frequency for TSH in this context, according to the Royal college of pathologists guidelines?

A 54 year old man sees his GP having noticed new swelling of both legs. He has a backgound of hypertension, is an ex-smoker and consumes 40 units ofvalcohol per week. The GP requests a set of investigations which return the following results: Sodium. 134 mmol/L Potassium. 4.3 mmol/L Creatinine. 124 umol/L ALP. 104 IU /L ALT. 32 IU/L Albumin. 17 g/L Total cholesterol 7.1 mmol/L Triglycerides. 4.52 mmol/L 24 hour urinary protein 4.1 g/24 hrs What is the likely underlying diagnosis?

A 72 year old woman is seen by her general practitioner after noticing a lump in her right breast. A diagnosis of breast cancer with lymphatic spread is confirmed through imaging and biopsy, leading to a referral to Oncology for further management. Which tumor marker can be used for monitoring of breast cancer?

A colleague has been investigating a 55 year old man for hypertension. As part of his assessment, he is looking to check aldosterone and renin levels and he wonders about patient preparation and sampling requirements. Which of the following medications exerts the least confounding effect on aldosterone and renin levels?

A 34 year old woman with a background of Crohn's disease presents with a rash over her face and perineal area. On further questioning, she reports hair thinning and diarrhea. Which of the following micronutrient deficiencies is most likely to account for this presentation?

A 54 year old man sees his GP having noticed new swelling of both legs. He has a backgound of hypertension, is an ex-smoker and consumes 40 units ofvalcohol per week. The GP requests a set of investigations which return the following results: Sodium. 134 mmol/L Potassium. 4.3 mmol/L Creatinine. 124 umol/L ALP. 104 IU /L ALT. 32 IU/L Albumin. 17 g/L Total cholesterol 7.1 mmol/L Triglycerides. 4.52 mmol/L 24 hour urinary protein 4.1 g/24 hrs What is the likely underlying diagnosis?

A 62 year old woman with known type 2 diabetes mellitus requires escalation of treatment. Her doctor decides to commence a thiazoldinedione. What is the mechanism of action of thiazolidinedione?

The Friedwald formula is used to calculate the LDL cholesterol, using total cholesterol, HDL cholesterol and triglycerides. Above which triglyceride level is this formula considered invalid?

A 39 year old man is on anticonvulsant treatment, and has recently had drug levels checked. The neurology consultant wasn't sure as to which of the following drugs required correction for Albumin concentration:

An 8 months old infant with suspected cystic fibrosis undergoes a chloride sweat test. The following results are obtained: Sample volume: 12 uL Sweat Chloride: 35 mmol/L What would be the best interpretation of these results?

A 75 year old man with a background of ischaemia heart disease, type 2 diabetes, and Parkinson's disease is found to have ketones on a urine dipstick. No other abnormalities are noted. Which of his medications could account for this?

A 42 year old woman is seen in the gastroenterology clinic, having been referred with symptoms of bloating and loose stools. Among other tests, a fecal calprotectin and fecal elastase are requested with the following results: Fecal calprotectin < 50 ug/g stool Fecal elastase > 200 ug/g stool Which diagnosis is most in keeping with these results?

A 42 year old woman with hyperthyroidism develops neutrophil while on carbimazole treatment. A decision is made to switch to propylthiouracil (PTU). What is the mechanism of action of PTU?

A 50 year old woman presents with symptoms of gastrointestinal reflux and profuse watery diarrhea, and is found to have hypokalemia on initial bloods. A CT scan is arranged and demonstrates a pancreatic mass and associated liver lesions. What is the probable cause for these findings?

A 37 year old man has recently emigrated from South America. He sees his GP having noticed a peeling erythematous rash and loose stools. During the consultation, his wife reports that he has been increasingly forgetful lately. Which vitamin deficiency, if present, could account for this presentation?

A 32 year old woman sees her GP having noticed irregular periods over the last year. A number of blood tests are requested, but notably the prolactin is found to be 1300 mU/L. She has a background of schizophrenia but cannot recall her medications. Which of the following antipsychotics does NOT typically cause hyperprolactinemia?

A 3 days old newborn is under investigation for hypoglycemia. During an episodes, where plasma glucose was 2.0 mmol/L, the beta hydroxybutyrate was < 0.1 mmol/L with free fatty acids of < 0.2 mmol/L. What is the probable cause of hypoglycemia?

A 2 week old baby is being assessed for jaundice, and the following results are obtained: Total bilirubin 410 umol/L Conjugated bilirubin 12 umol/L Which of these could account for these results?

A 74 year old man is admitted to hospital with shortness of breath. He is found to have bilateral pleural effusions, larger on the right side. A diagnostic aspiration is performed, and initial results show a fluid protein of 32 g/L (serum protein 77 g/L). Which of the following part of Light's criteria would suggest an exudate?

A 39 year old woman with megaloblastic anemia is thought to have B12 malabsroption. Where in the intestine is B12 predominantly absorbed?

A 24 year old man is seen following head trauma. He has ongoing rhinorrhea and the team are concerned this may represent a CSF leak. Which investigation would you recommend?

A 24 year old woman with hypokalemia undergoes investigation for her electrolyte abnormality, and the following results are obtained: Sodium 142 mmol/L. (135 - 145) Potassium 3.1 mmol/L. (3.5 - 5.0) Calcium 2.55 mmol/L. (2.2 - 2.6) Magnesium 0.64 mmol/L (0.65 - 1.05) Bicarbonate 34 mmol/L. (22 - 26) Urine Ca 0.9 mmol/24hr. (2.5 - 7.5) Which diagnosis do these results suggest?

A 49 year old man is undergoing Regular venesection for hereditary hemochromatosis. Which of the following parameters is particularly important to monitor during regular venesection?

A 39 year old man attends his GP clinic complaining of fatigue. His hormonal profile show the following: TSH. 1.84 mU/L (0.4 - 4.0) FT4. < 5.2 pmol/L (12 - 22) FSH. 1.2 IU/L (1.5 - 12.4) LH. 1.0 IU/L (1.8 - 8.6) Free testosterone 4.6 nmol/L. (8.7 - 25.1) What is the likely cause of the presentation?

A 56 year old man is being investigated for hypertension and a change of appearance. He undergoes an overnight dexamethasone suppression test, and has a 9 am cortisol of 102 nmol/L. He is subsequently referred to endocrinology but further workup is not suggestive of Cushing's syndrome. Which of the following drugs may have produced a false positive result on overnight dexamethasone suppression testing?

A baby is born with ambiguous genitalia. Which biochemical test can be used to determine if testicular tissue is present?

A 42 year old woman has features of hyperthyroidism, and her labs show the following: TSH < 0.01 mU/L (0.4 - 4.0) FT4 31.9 pmol/L (12 - 22) FT3 8.2 pmol/L (2 - 7) Thyroglobulin < 0.2 ug/L (1.4 - 29.2) What is the cause of these results?

A 78 year old man is admitted with new confusion and ataxia. The medical team are concerned about Wernicke's syndrome. Replacement of which substance is required for treatment of this condition?

A 62 year old man is admitted to the emergency department after an overdose of digoxin. Which of the following is an indication for considering digoxin specific antibody treatment?

A 54 year old man, known to have hyperglycemia, is referred to the Endocrine clinic for further investigations. The following labs were seen: Adjusted Calcium 2.9 mmol/L (2.2 - 2.6) Creatinine 100 umol/L (80 - 120) PTH 5.8 pmol/L (1.6 - 6.9) Random Urine Ca 3.5 mmol/L Urine Creatinine 5 mmol/L What is the most likely diagnosis?