KFP – Endocrine and metabolic health

Emily Johnson, aged 27, presents with a 6-month history of increasing fatigue, 5 kg unintentional weight loss, and occasional dizziness. She reports feeling lightheaded on standing and has noticed increased pigmentation on her knuckles and inside her mouth. She also mentions irregular periods and salt cravings.

Medications: None

Allergies: Nil known

Past history: Unremarkable

Family history: Mother has Hashimoto thyroiditis, father has type 1 diabetes mellitus

Social history: Works as a primary school teacher, non-smoker, drinks socially

Examination findings: BP 95/60 mmHg supine, 78/50 mmHg standing. HR 92 bpm. Generalised hyperpigmentation noted on the skin creases and buccal mucosa. No goitre or lymphadenopathy. Normal cardiorespiratory and abdominal exams.

Investigations:

What is the most appropriate management at this stage? Select three (3) from the following list:

Michael Davis, aged 56, presents for review of his poorly controlled type 2 diabetes. He reports feeling fatigued and occasionally dizzy. He denies chest pain but has recently gained 5 kg over 3 months. He is unsure about how often he takes his medications and admits to sometimes skipping doses.

Medications: Metformin XR 1000 mg daily, Empagliflozin 10 mg daily (irregular adherence)

Allergies: Nil known

Past history: Type 2 diabetes (diagnosed 6 years ago), hypertension, hyperlipidaemia

Family history: Father had myocardial infarction at 58, mother has type 2 diabetes

Social history: Smokes 10 cigarettes/day, works as a mechanic, minimal exercise

Examination findings: BMI 33.2 kg/m², BP 152/94 mmHg, HR 76 bpm. No peripheral oedema, fundoscopy shows background diabetic retinopathy. Peripheral pulses intact, but decreased sensation to 10g monofilament on both feet.

Investigations:

What are the most appropriate management steps at this point? Select four (4) from the following list:

Sophia Nguyen, aged 33, presents with increasing fatigue, cold intolerance, and difficulty losing weight despite regular exercise and a controlled diet. She also reports heavy, prolonged menstrual periods over the past 6 months and recent onset of constipation. She has no significant past medical history and takes no regular medications.

Medications: None

Allergies: Nil known

Past history: Nil significant

Family history: Mother has hypothyroidism and vitiligo

Social history: Works as an accountant, does not smoke or drink alcohol

Examination findings: BP 112/76 mmHg, HR 56 bpm, BMI 28.1 kg/m². Dry skin noted on forearms, delayed ankle reflex relaxation, mild periorbital puffiness. No goitre or thyroid nodules palpable.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Rajiv Patel, aged 63, presents with a three-month history of worsening fatigue, thirst, frequent urination, and blurred vision. He has also experienced intermittent tingling in his feet and has lost 4 kg unintentionally. He has not seen a doctor in over 10 years.

Medications: Nil

Allergies: Nil known

Past history: Nil significant recorded

Family history: Father had type 2 diabetes, mother had hypertension

Social history: Works as a taxi driver, sedentary lifestyle, drinks 3–4 beers most evenings

Examination findings: BP 148/92 mmHg, BMI 31.8 kg/m², reduced sensation to monofilament in both feet, no ulcers or deformities, mild erythema around both eyes

Investigations:

What are the most appropriate initial steps in management? Select three (3) from the following list:

Anna Fraser, aged 22, presents with secondary amenorrhoea and worsening acne over the past year. She has also noted gradual weight gain and increased facial hair growth. Her menarche was at age 12, and she previously had regular monthly cycles until 18 months ago. She is not on any contraception and is not sexually active.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has type 2 diabetes, sister has PCOS

Social history: University student, lives with parents, BMI 31.4 kg/m²

Examination findings: BP 132/86 mmHg, moderate facial hirsutism, acne over cheeks and jawline, no galactorrhoea or virilisation, pelvic exam deferred by patient

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Thomas Lynch, aged 45, presents with increasing fatigue, low mood, and reduced libido over the past 6 months. He has also noted a reduction in shaving frequency and occasional erectile dysfunction. He denies hot flushes, weight change, or galactorrhoea. He and his partner have been trying to conceive for 2 years without success.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Brother has type 1 diabetes

Social history: Works in IT, non-smoker, drinks 6–8 standard drinks per week, no recreational drugs

Examination findings: BMI 26.5 kg/m², BP 122/80 mmHg, sparse chest hair, testicular volume reduced bilaterally

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Margaret O’Donnell, aged 71, presents for review after recent blood tests ordered during a routine check-up. She reports mild fatigue but denies weight loss, thirst, or urinary symptoms. She is otherwise well and independent in activities of daily living.

Medications: Ramipril 10 mg daily, Atorvastatin 20 mg daily

Allergies: Nil known

Past history: Hypertension, hypercholesterolaemia

Family history: Sister has osteoporosis, father had myocardial infarction at 70

Social history: Retired teacher, walks daily, lives alone, non-smoker

Examination findings: BMI 24.2 kg/m², BP 128/76 mmHg, HR 72 bpm, no goitre or lymphadenopathy, no tremor, normal reflexes

Investigations:

What are the most appropriate next steps in management? Select two (2) from the following list:

Leila Bakri, aged 30, presents with concerns about excessive sweating, palpitations, irritability, and unintentional weight loss of 6 kg over the past two months. She also notes difficulty sleeping and tremors in her hands. She has regular menstrual cycles and no recent illness.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has rheumatoid arthritis, sister has Graves disease

Social history: Office worker, non-smoker, does not drink alcohol

Examination findings: BP 138/76 mmHg, HR 108 bpm, fine tremor of outstretched hands, warm moist skin, mild bilateral lid lag. Diffuse, non-tender goitre with no nodules. No pretibial myxoedema or ophthalmopathy

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Jacob Williams, aged 52, presents with recurrent episodes of painful redness and swelling in the right great toe. He reports three such episodes in the past year, each resolving over several days. He also describes occasional aching in his knees and ankles. His diet includes frequent red meat and beer on weekends. He is concerned as his father had similar symptoms and developed chronic joint problems.

Medications: Perindopril 5 mg daily for hypertension

Allergies: Nil known

Past history: Hypertension

Family history: Father had gout and chronic kidney disease

Social history: Warehouse worker, drinks 3–4 beers on weekends, occasional NSAID use

Examination findings: Mild swelling and erythema over the first MTP joint of the right foot. Joint is warm and tender to touch. No tophi or joint deformities noted. Cardiovascular and other systemic exams unremarkable.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Sarah Thompson, aged 28, presents with concerns about recurrent episodes of hypoglycaemia. She describes feeling lightheaded, sweaty, and shaky when she skips meals, which resolves promptly with food. These episodes have been occurring several times per week over the past two months. She has not lost weight and remains otherwise well.

Medications: Oral contraceptive pill

Allergies: Nil known

Past history: Nil significant

Family history: Mother has type 2 diabetes

Social history: Works as a nurse, exercises regularly, denies alcohol or recreational drug use

Examination findings: BMI 23.8 kg/m², BP 116/72 mmHg, HR 68 bpm, no goitre, no skin hyperpigmentation, no masses or hepatosplenomegaly

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Peter Zhang, aged 66, presents with ongoing fatigue, low mood, and muscle weakness. He was recently hospitalised for a low-trauma vertebral fracture. He reports minimal sun exposure and follows a strict vegan diet. He does not take any supplements. There is no history of malignancy or recent corticosteroid use.

Medications: None

Allergies: Nil known

Past history: Hypertension (well controlled), no history of chronic illness

Family history: Mother had osteoporosis; no family history of endocrine disease

Social history: Retired, lives alone, walks with a cane due to back pain, non-smoker

Examination findings: Height 165 cm (previous 168 cm), BMI 21.3 kg/m². Kyphosis noted, proximal muscle weakness in lower limbs, no focal neurological signs

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Emily Carter, aged 36, presents with new onset hypertension noted at a workplace health check. She reports occasional headaches but no palpitations, chest pain, or visual symptoms. She has gained 4 kg over the past 3 months. There is no family history of hypertension under age 50. Her cycles are regular, and she is not taking any hormonal contraception.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Father has hypertension diagnosed at 62, mother has hypothyroidism

Social history: Lawyer, high stress job, does not smoke or drink alcohol

Examination findings: BP 162/98 mmHg (repeat on both arms), BMI 29.6 kg/m², no cushingoid features or goitre, heart sounds dual, no bruits

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

David Russo, aged 49, presents for review after abnormal blood tests ordered during a health check. He feels well, has no fatigue, weight loss, or polyuria. He reports a long-standing craving for salty foods. He denies vomiting, abdominal pain, or skin changes.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Sister has coeliac disease

Social history: Construction worker, non-smoker, drinks 2–3 standard drinks on weekends

Examination findings: BP 102/66 mmHg, HR 78 bpm. No hyperpigmentation or signs of dehydration. No goitre. Weight stable, BMI 23.4 kg/m²

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Natalie Green, aged 40, presents with menstrual irregularity, recent onset of acne, and deepening of her voice over the past six months. She also reports increased muscle mass and facial hair growth. Her cycles were previously regular but have become infrequent and lighter. She has no significant past medical history and is not on any hormonal therapy.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Sister has polycystic ovary syndrome (PCOS)

Social history: Gym instructor, strict high-protein diet, denies alcohol or recreational drug use

Examination findings: BP 128/78 mmHg, BMI 25.4 kg/m². Temporal hair recession, acne over jawline, hirsutism (Ferriman-Gallwey score 14), clitoromegaly present. No goitre. No abdominal masses.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Mohammed Al-Sayed, aged 59, presents for follow-up after recent blood tests revealed elevated fasting glucose and HbA1c. He has no specific symptoms but reports increased fatigue over the past few months. He denies polyuria, polydipsia, or weight loss. He is concerned because his brother was recently diagnosed with diabetes-related kidney failure.

Medications: None

Allergies: Nil known

Past history: Hyperlipidaemia (diet-controlled)

Family history: Brother has type 2 diabetes with complications; father died from myocardial infarction at age 60

Social history: Taxi driver, sedentary lifestyle, drinks 1–2 beers on weekends, no smoking

Examination findings: BMI 32.5 kg/m², BP 142/88 mmHg, waist circumference 106 cm. No peripheral oedema, fundoscopy normal. Foot exam: intact pulses, no ulcers, decreased vibration sense at great toes bilaterally.

Investigations:

What are the most appropriate next steps in management? Select four (4) from the following list:

Lucy Armstrong, aged 32, presents with infertility concerns. She and her partner have been trying to conceive for over 18 months without success. She reports regular periods every 28 days, no dysmenorrhoea, and no history of pelvic infections or surgery. She has no significant medical history and takes no regular medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother entered menopause at age 41

Social history: Office worker, BMI 20.2 kg/m², non-smoker, drinks socially

Examination findings: BP 110/70 mmHg, HR 68 bpm. Normal secondary sexual characteristics. No hirsutism or acne. Pelvic exam: normal-sized uterus, no adnexal masses, no tenderness

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Anthony Li, aged 47, presents for review after feeling increasingly fatigued and unwell over several months. He reports joint aches, low libido, and occasional abdominal discomfort. He denies weight loss, but his wife has noticed that his skin appears darker than usual, even without sun exposure. He drinks 1–2 glasses of wine most nights.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Brother diagnosed with ‘liver disease’ in his 50s; no other known chronic illnesses

Social history: Works as an accountant, non-smoker, no recreational drugs

Examination findings: BP 130/84 mmHg, HR 74 bpm, BMI 26.5 kg/m². Mild hepatomegaly, increased skin pigmentation over forearms and face. Testes small bilaterally.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Amanda Tilley, aged 62, presents with mild tiredness and unintentional weight gain of 3 kg over 6 months. She has no constipation, cold intolerance, depression, or hair loss. Her periods ceased at age 51. She attends for routine screening bloods and reports feeling generally well.

Medications: Rosuvastatin 10 mg daily

Allergies: Nil known

Past history: Hypercholesterolaemia

Family history: Sister has autoimmune thyroid disease

Social history: Retired librarian, non-smoker, drinks one glass of wine most evenings

Examination findings: BMI 26.1 kg/m², BP 134/78 mmHg, HR 64 bpm. No goitre, normal skin and reflexes. No peripheral oedema.

Investigations:

What are the most appropriate next steps in management? Select two (2) from the following list:

James Whitaker, aged 37, presents with recurrent episodes of sweating, palpitations, and a sense of panic, often occurring without clear triggers. He reports intermittent pounding headaches and recent onset of high blood pressure. He denies stimulant use, and there is no personal or family history of anxiety or cardiac disease.

Medications: None

Allergies: Nil known

Past history: Nil significant

Family history: Father had ‘adrenal tumour’ removed in his 40s

Social history: Construction worker, non-smoker, drinks 1–2 beers on weekends

Examination findings: BP 168/100 mmHg (seated), HR 92 bpm, BMI 27.0 kg/m². No tremor or thyroid enlargement. No features of Cushing’s syndrome.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Kylie Brooks, aged 25, presents with concerns about persistent fatigue, difficulty concentrating, and cold hands and feet. She reports irregular menstrual cycles since menarche and has gained 7 kg in the past year despite regular exercise. She also reports occasional bloating and loose stools. She has never been pregnant.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Sister has type 1 diabetes and hypothyroidism

Social history: Works as a primary school teacher, non-smoker, lives with partner

Examination findings: BMI 27.8 kg/m², BP 104/68 mmHg, HR 60 bpm. Dry skin noted on arms, cool extremities, mild abdominal bloating. No goitre or lymphadenopathy. No signs of anaemia or peripheral oedema.

Investigations:

What are the most appropriate next steps in management? Select four (4) from the following list:

Matthew O’Brien, aged 53, presents for follow-up after routine screening bloods revealed elevated calcium. He feels well with no specific symptoms, but on further questioning he reports mild fatigue and occasional constipation. He has not had any recent kidney stones, fractures, or abdominal pain.

Medications: Multivitamin daily

Allergies: Nil known

Past history: Nil significant

Family history: Mother had osteoporosis; no family history of endocrine conditions

Social history: Works as a civil engineer, non-smoker, drinks socially

Examination findings: BP 138/82 mmHg, BMI 26.9 kg/m², no bone tenderness, no palpable neck masses

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Angela Morrison, aged 45, presents with frequent urination, nocturia, and persistent thirst. She has recently increased her water intake to 5–6 litres per day. She denies any recent illness, fever, or vomiting. There is no history of diabetes, and she has not started any new medications. Her menstrual cycles are regular.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Father has hypertension, no history of diabetes

Social history: Works as a pharmacist, non-smoker, drinks socially

Examination findings: BP 110/70 mmHg, HR 86 bpm, BMI 22.4 kg/m². Mucous membranes slightly dry. No oedema. Neurological exam normal.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Helen Black, aged 68, presents for review of her recently diagnosed osteoporosis. She reports a recent low-trauma distal radius fracture after a fall while gardening. She denies chronic back pain, loss of height, or previous fractures. She has gone through menopause at 52 and has not used hormone therapy.

Medications: Calcium + vitamin D supplement daily (started 2 weeks ago)

Allergies: Nil known

Past history: Hypertension, well controlled

Family history: Mother had a hip fracture at age 74

Social history: Lives independently, walks daily, non-smoker, moderate alcohol intake

Examination findings: BP 132/76 mmHg, BMI 22.8 kg/m². No kyphosis. No tenderness on spinal palpation.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Samuel Reyes, aged 39, presents with recent onset of fatigue, low mood, and reduced libido. He has also noticed loss of morning erections and difficulty building muscle despite regular gym training. He and his partner have been trying to conceive for 18 months. He denies any anabolic steroid use or chronic illness.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Father has type 2 diabetes, mother has hypothyroidism

Social history: Accountant, non-smoker, moderate alcohol use (6–8 drinks/week)

Examination findings: BMI 25.8 kg/m², BP 122/76 mmHg, testicular volume reduced bilaterally, no gynaecomastia, normal secondary sexual characteristics otherwise

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Danielle Foster, aged 58, presents for review of long-standing type 2 diabetes. She reports generally good glycaemic control but notes increased urinary frequency and fatigue over the past few months. She denies thirst, weight loss, or urinary urgency. Her home blood glucose readings have been averaging 7–9 mmol/L. She is otherwise well.

Medications: Metformin XR 1000 mg daily, Gliclazide MR 60 mg daily, Atorvastatin 20 mg daily, Ramipril 5 mg daily

Allergies: Nil known

Past history: Type 2 diabetes (diagnosed 12 years ago), hypertension, dyslipidaemia

Family history: Father had myocardial infarction at 62

Social history: Retired school teacher, non-smoker, BMI 30.2 kg/m², moderate alcohol use

Examination findings: BP 138/84 mmHg, HR 78 bpm, no peripheral oedema, peripheral pulses present, decreased monofilament sensation in both feet

Investigations:

What are the most appropriate next steps in management? Select four (4) from the following list:

Emily Watson, aged 26, presents with secondary amenorrhoea and weight loss over the past 6 months. She reports increased exercise intensity as she is training for a marathon and has also reduced her calorie intake. She denies heat intolerance, tremor, or palpitations. Her last period was 7 months ago, and previously they were regular. She is not on contraception and has no plans for pregnancy in the near future.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has osteoporosis

Social history: Marketing executive, non-smoker, drinks socially, runs 50–60 km/week

Examination findings: BMI 18.1 kg/m², HR 52 bpm, BP 100/68 mmHg. No goitre, no hirsutism or acne. Normal reflexes. No signs of virilisation or galactorrhoea

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Victor Tan, aged 61, presents with worsening fatigue, nausea, and postural dizziness over the past few months. He also reports darkening of his skin, including areas not exposed to the sun. He has lost approximately 4 kg unintentionally. There is no recent travel or gastrointestinal illness.

Medications: Nil

Allergies: Nil known

Past history: Hypercholesterolaemia

Family history: Sister has Hashimoto thyroiditis

Social history: Retired bus driver, non-smoker, moderate alcohol intake

Examination findings: BP 92/58 mmHg (drops to 78/48 on standing), HR 88 bpm. Generalised hyperpigmentation noted on palmar creases, elbows, and oral mucosa. No goitre. Weight 68 kg (previously 72 kg).

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Linda Novak, aged 34, presents with a 6-month history of progressive weight gain, fatigue, and mood changes. She reports difficulty sleeping, reduced concentration, and frequent bruising. She has also developed facial rounding and increased abdominal girth with thin arms and legs. Her menstrual cycles have become irregular.

Medications: Nil

Allergies: Nil known

Past history: Asthma (mild, not currently using corticosteroids)

Family history: Mother has type 2 diabetes and hypertension

Social history: Works in finance, no alcohol or smoking, exercises rarely

Examination findings: BP 154/96 mmHg, HR 88 bpm, BMI 30.1 kg/m². Moon facies, supraclavicular fat pads, violaceous striae over abdomen, central obesity with proximal muscle weakness. No goitre or hirsutism.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Thomas Bell, aged 42, presents with persistent headaches, increased sweating, and recently noticed his hands and feet have become larger. He also reports that his wedding ring no longer fits, and his shoes feel tighter. His partner has commented that his facial features appear broader. He denies visual changes, fatigue, or recent weight loss.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: No known endocrine conditions

Social history: Works in construction, non-smoker, minimal alcohol

Examination findings: BP 142/92 mmHg, HR 76 bpm, BMI 29.2 kg/m². Coarse facial features, enlarged tongue, prominent jaw, and increased hand span noted. No visual field deficits. Cardiovascular and neurological examinations are otherwise unremarkable.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Michael Jensen, aged 50, presents with ongoing tiredness, reduced muscle mass, and erectile dysfunction. He reports decreased libido and lack of energy despite maintaining a consistent gym routine. He denies hot flushes or testicular pain. He and his partner are not trying to conceive.

Medications: None

Allergies: Nil known

Past history: Obstructive sleep apnoea (uses CPAP), dyslipidaemia

Family history: Brother has type 2 diabetes; father had prostate cancer

Social history: Works in IT, non-smoker, drinks 2–3 beers on weekends, BMI 31.2 kg/m²

Examination findings: BP 128/80 mmHg, HR 72 bpm. Reduced body hair, mild central adiposity, normal testicular volume. No gynaecomastia or thyroid enlargement.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Rachel Stevens, aged 31, presents with increasing fatigue and weight gain over the past 4 months. She also reports constipation, dry skin, and heavy menstrual periods. She had her first child 10 months ago and is currently breastfeeding. She denies postnatal depression but feels she is “slower” mentally than usual.

Medications: None

Allergies: Nil known

Past history: G1P1, no complications during pregnancy or delivery

Family history: Mother has hypothyroidism

Social history: On maternity leave, non-smoker, occasional wine

Examination findings: BP 110/72 mmHg, HR 58 bpm, BMI 24.6 kg/m². Dry skin on arms, delayed ankle reflexes. No goitre or thyroid nodules.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Jonathan McKay, aged 35, presents with fatigue, muscle cramps, and tingling in his fingertips. He reports that these symptoms started a few months after undergoing a total thyroidectomy for papillary thyroid cancer. He is currently on thyroxine replacement therapy.

Medications: Thyroxine 150 mcg daily

Allergies: Nil known

Past history: Papillary thyroid carcinoma (surgically treated 6 months ago)

Family history: Nil of note

Social history: Accountant, non-smoker, occasional alcohol

Examination findings: BP 124/78 mmHg, HR 72 bpm. Chvostek’s and Trousseau’s signs are positive. No thyromegaly or lymphadenopathy.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Sophie Tran, aged 29, presents with concerns about excessive sweating, unintentional weight loss of 6 kg over 3 months, and increased irritability. She reports palpitations, tremors, and loose stools. Her menstrual periods have become lighter and less frequent. She has no significant past medical history.

Medications: Nil

Allergies: Nil known

Past history: Nil

Family history: Mother has Graves’ disease

Social history: Works as a lawyer, non-smoker, drinks socially, no recent travel

Examination findings: HR 112 bpm, BP 136/84 mmHg, BMI 21.3 kg/m². Fine tremor, warm moist skin, mild lid lag. Diffuse, non-tender goitre present. No thyroid eye signs or pretibial myxoedema.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Andrew Callaghan, aged 67, presents with lethargy, nausea, and mild confusion. He recently began taking hydrochlorothiazide for hypertension. His daughter reports that he has been more forgetful and unsteady on his feet in the past week. He denies vomiting or diarrhoea.

Medications: Hydrochlorothiazide 25 mg daily (started 3 weeks ago), amlodipine 5 mg daily

Allergies: Nil known

Past history: Hypertension, osteoarthritis

Family history: Nil of note

Social history: Retired teacher, lives alone, drinks one glass of wine most nights, no smoking

Examination findings: BP 118/70 mmHg, HR 76 bpm, BMI 23.8 kg/m². Mild postural drop in BP. Alert but slightly disoriented to date. No focal neurological signs. Dry mucous membranes.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Alicia Moore, aged 47, presents with difficulty losing weight, irregular menstrual cycles, and increased facial hair over the past year. She also reports mild acne and scalp hair thinning. She has no significant past medical history. Her periods now occur every 6–8 weeks and are heavier than usual.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has type 2 diabetes

Social history: School principal, BMI 31.4 kg/m², non-smoker, drinks wine socially

Examination findings: BP 132/84 mmHg, Ferriman-Gallwey score 10 (upper lip, chin, lower abdomen), mild androgenic alopecia, no clitoromegaly or deep voice. No goitre. Acanthosis nigricans present on neck.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Benjamin Scott, aged 63, presents with increasing thirst, nocturia, and blurred vision over the past 2 months. He reports having gained 5 kg in the past year and admits to a sedentary lifestyle and regular intake of soft drinks. He has not had regular medical check-ups.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Father had type 2 diabetes and died from a stroke at age 70

Social history: Retired electrician, BMI 32.4 kg/m², drinks 3–4 beers on weekends, non-smoker

Examination findings: BP 144/86 mmHg, HR 84 bpm. Central adiposity noted, no peripheral oedema. Foot exam: diminished sensation to monofilament testing bilaterally. Visual acuity reduced.

Investigations:

What are the most appropriate next steps in management? Select four (4) from the following list:

Charlotte Nguyen, aged 39, presents with fatigue, cold intolerance, and difficulty losing weight despite increased exercise. She also reports recent onset of constipation and menorrhagia. She denies depression or other psychological symptoms. Her last pregnancy was 3 years ago and she is currently using a copper IUD.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has rheumatoid arthritis

Social history: Office worker, non-smoker, BMI 27.6 kg/m², moderate alcohol

Examination findings: HR 58 bpm, BP 118/74 mmHg. Dry skin on forearms and legs. Mildly delayed reflexes. No goitre or nodules.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Peter Wallace, aged 70, presents with persistent hypercalcaemia noted on recent blood tests ordered for fatigue and mild cognitive slowing. He denies constipation, polyuria, or bone pain. He has no history of fractures or renal stones. He is otherwise well and takes no regular medications except vitamin D supplements.

Medications: Vitamin D 1000 IU daily

Allergies: Nil known

Past history: Hypertension (well-controlled), no malignancy

Family history: Brother had prostate cancer, no endocrine history

Social history: Retired builder, BMI 26.5 kg/m², non-smoker, drinks one glass of wine daily

Examination findings: BP 130/78 mmHg, HR 72 bpm, no neck masses, no bone tenderness or neuromuscular abnormalities

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Isobel Kent, aged 46, presents with worsening fatigue, irregular periods, and difficulty concentrating. She also mentions feeling “foggy” and has gained 4 kg over the past 3 months despite no changes in diet. She reports intermittent headaches but no visual changes. She is not on any regular medications and has not been pregnant.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Sister has type 1 diabetes

Social history: Works in hospitality, BMI 26.1 kg/m², non-smoker, drinks alcohol socially

Examination findings: BP 100/68 mmHg, HR 64 bpm. No goitre or skin changes. Normal eye movements, no visual field loss. No galactorrhoea. Mildly delayed ankle reflexes. Normal secondary sexual characteristics.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Angela Reid, aged 59, presents with a 6-month history of gradual fatigue, mild ankle swelling, and recent difficulty controlling her blood pressure. She also reports increased bruising and easy skin tearing. Her blood pressure has been well controlled until recently. She takes no corticosteroids and denies alcohol or drug use.

Medications: Perindopril 5 mg daily, Amlodipine 5 mg daily

Allergies: Nil known

Past history: Hypertension, osteoarthritis

Family history: Mother had osteoporosis, father had ischaemic heart disease

Social history: Retired administrative worker, non-smoker, no alcohol

Examination findings: BP 154/92 mmHg, HR 78 bpm, BMI 28.4 kg/m². Facial plethora, central obesity, scattered ecchymoses, thin skin, mild ankle oedema. No striae or muscle wasting.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Emily Zhao, aged 24, presents with worsening acne, hirsutism, and irregular periods. She began experiencing menstrual irregularity during adolescence, but her symptoms have become more pronounced over the past year. She has gained 6 kg in the last 12 months and is increasingly distressed by facial hair growth.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother has type 2 diabetes

Social history: Student, non-smoker, drinks occasionally, BMI 29.5 kg/m²

Examination findings: BP 122/78 mmHg, Ferriman-Gallwey score 12, moderate acne, no clitoromegaly or voice deepening. No goitre. Waist circumference 92 cm. No signs of Cushing’s syndrome.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

David Foley, aged 58, presents with recently diagnosed type 2 diabetes following a routine health check. He reports minimal symptoms but mentions increased thirst and waking to urinate once or twice at night. He is otherwise well. He has a family history of diabetes and cardiovascular disease.

Medications: Nil

Allergies: Nil known

Past history: Nil chronic conditions

Family history: Father had myocardial infarction at age 60; mother has type 2 diabetes

Social history: Works as a bus driver, BMI 30.8 kg/m², non-smoker, drinks socially, sedentary lifestyle

Examination findings: BP 138/82 mmHg, HR 76 bpm. No peripheral oedema, peripheral pulses intact, monofilament sensation reduced bilaterally

Investigations:

What are the most appropriate next steps in management? Select four (4) from the following list:

Olivia Matthews, aged 51, presents with recurrent episodes of sweating, palpitations, and shakiness occurring mostly in the late morning. These symptoms improve quickly after eating. She has also noticed some recent weight gain and fatigue. There is no history of diabetes, and she is not taking any medications or supplements.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Sister has hypothyroidism

Social history: Office worker, BMI 26.1 kg/m², non-smoker, drinks socially

Examination findings: BP 124/76 mmHg, HR 72 bpm. Physical exam unremarkable.

Investigations during symptomatic episode:

What are the most appropriate next steps in management? Select three (3) from the following list:

Mark Jenkins, aged 48, presents with persistent hypertension that has been difficult to control on two medications. He denies headaches, palpitations, or diaphoresis. He has no history of diabetes or kidney disease. He has gained 4 kg in the past year despite no major lifestyle changes.

Medications: Perindopril 10 mg daily, Amlodipine 10 mg daily

Allergies: Nil known

Past history: Hypertension diagnosed 3 years ago

Family history: Father had early-onset hypertension; mother has hypercholesterolaemia

Social history: Warehouse manager, BMI 30.1 kg/m², non-smoker, drinks 1–2 beers nightly

Examination findings: BP 162/96 mmHg, HR 76 bpm. No peripheral oedema or abdominal bruits. Normal fundoscopy and cardiovascular exam.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Lauren Peters, aged 32, presents with recent onset of anxiety, palpitations, and significant weight loss over the past 2 months. She delivered her second child 4 months ago. She is not breastfeeding and is otherwise healthy. She denies heat intolerance or neck pain. She has no personal or family history of thyroid disease.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Nil of note

Social history: School teacher, BMI 23.1 kg/m², non-smoker

Examination findings: HR 102 bpm, BP 118/74 mmHg. Mild tremor in hands. No goitre or thyroid tenderness. No thyroid eye signs.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Samuel O’Brien, aged 66, presents with longstanding type 2 diabetes and increasing difficulty with glucose control despite adherence to his medications. He also reports weight gain, occasional ankle swelling, and recent erectile dysfunction. He denies chest pain or shortness of breath. He is concerned about the risk of complications.

Medications: Metformin XR 1 g twice daily, Gliclazide MR 60 mg daily, Atorvastatin 20 mg daily, Perindopril 5 mg daily

Allergies: Nil known

Past history: Type 2 diabetes (diagnosed 12 years ago), hypertension, dyslipidaemia

Family history: Brother had myocardial infarction at 55

Social history: Retired builder, BMI 31.5 kg/m², non-smoker, drinks alcohol rarely

Examination findings: BP 136/82 mmHg, HR 72 bpm. Mild peripheral oedema. Diminished monofilament sensation bilaterally. No retinopathy on recent screening.

Investigations:

What are the most appropriate next steps in management? Select four (4) from the following list:

Nadia Abbas, aged 42, presents with increasing fatigue, light-headedness when standing, and salt craving. She also reports irregular periods and recent unintentional weight loss of 3 kg over 2 months. She has no recent illness or infections. She has noted skin darkening, particularly in skin folds and over her knuckles.

Medications: Nil

Allergies: Nil known

Past history: Vitiligo diagnosed at age 36

Family history: Sister has type 1 diabetes

Social history: Works in retail, BMI 22.4 kg/m², non-smoker

Examination findings: BP 94/58 mmHg (drops to 78/50 mmHg on standing), HR 88 bpm. Hyperpigmentation noted on knuckles and buccal mucosa. No goitre or signs of thyroid disease.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Jacob Lin, aged 56, presents for routine follow-up of type 2 diabetes. He reports adherence to his medications and diet but has noticed gradual weight loss and more frequent hypoglycaemic episodes in the past 3 months. He denies gastrointestinal symptoms. His appetite is stable, and he is not experiencing polyuria or polydipsia.

Medications: Metformin XR 1 g daily, Gliclazide MR 60 mg daily, Empagliflozin 10 mg daily

Allergies: Nil known

Past history: Type 2 diabetes (diagnosed 8 years ago), hypertension, hyperlipidaemia

Family history: Father had pancreatic cancer, mother has hypertension

Social history: Office worker, BMI 21.8 kg/m², non-smoker, occasional alcohol use

Examination findings: BP 128/76 mmHg, HR 74 bpm. Mild muscle wasting noted. No goitre or abdominal tenderness. No peripheral oedema.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Thomas Redman, aged 38, presents with muscle weakness, weight gain, and poorly controlled blood pressure despite dual therapy. He also reports mood swings, sleep disturbance, and recent onset of easy bruising. On further questioning, he denies exogenous corticosteroid use.

Medications: Perindopril 10 mg daily, Amlodipine 10 mg daily

Allergies: Nil known

Past history: Hypertension diagnosed 2 years ago

Family history: Mother has hypothyroidism; father has type 2 diabetes

Social history: Project manager, BMI 31.7 kg/m², non-smoker, drinks 1–2 standard drinks on weekends

Examination findings: BP 158/94 mmHg, HR 84 bpm. Central adiposity, facial rounding, dorsocervical fat pad, purple striae on abdomen. No goitre. No proximal myopathy on exam.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list:

Priya Malhotra, aged 26, presents with secondary amenorrhoea and galactorrhoea for the past 4 months. She stopped the oral contraceptive pill 6 months ago and has not had a menstrual period since. She also reports recent headaches but denies visual disturbances or systemic symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother had early menopause at 40

Social history: University student, BMI 24.3 kg/m², non-smoker, does not drink alcohol

Examination findings: BP 114/70 mmHg, HR 72 bpm. Normal visual fields on confrontation testing. Expressible bilateral galactorrhoea. No goitre or signs of virilisation.

Investigations:

What are the most appropriate next steps in management? Select three (3) from the following list: