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Sample 1·Endocrinology
A 45-year-old woman with type 2 diabetes on metformin has HbA1c of 8.4%. She has BMI 34 and eGFR 78. What is the most appropriate next step?
- AAdd sulfonylurea
- ✓Add GLP-1 receptor agonist
- CSwitch to insulin
- DIncrease metformin to 3g/day
Explanation
GLP-1 RA is preferred in obese type 2 diabetics with inadequate control on metformin, offering weight loss and cardiovascular benefit.
Sample 2·Endocrinology
A 55-year-old with type 2 diabetes has HbA1c 8.2% on maximum metformin. eGFR 65. He has BMI 32 and a history of MI. Best add-on?
- AGliclazide
- ✓Empagliflozin
- CPioglitazone
- DSitagliptin
Explanation
SGLT2 inhibitors reduce cardiovascular events and are preferred add-ons in T2DM with established CVD.
Sample 3·Endocrinology
A 50-year-old presents with paroxysmal headaches, sweating and palpitations. BP 220/120 during episodes. Best initial test?
- ✓24-hour urinary metanephrines
- BSerum cortisol
- CRenin/aldosterone ratio
- DThyroid function
Explanation
Classic phaeochromocytoma triad; screen with plasma or 24-hour urinary metanephrines.
Sample 4·Endocrinology
A 55-year-old with primary hyperparathyroidism has calcium 2.95, PTH elevated. Which finding is an indication for parathyroidectomy?
- AAge >60
- BAsymptomatic hypercalcaemia
- ✓eGFR <60
- DSerum PTH twice normal
Explanation
Guidelines recommend surgery for hyperparathyroidism if eGFR <60, age <50, T-score <-2.5, or Ca >0.25 above upper limit.
Sample 5·Endocrinology
A 68-year-old man has serum sodium 118, urine osmolality 550, plasma osmolality 260, euvolaemic. Most likely diagnosis?
- ✓SIADH
- BDiabetes insipidus
- CAdrenal insufficiency
- DPsychogenic polydipsia
Explanation
Euvolaemic hyponatraemia with concentrated urine and low plasma osmolality is characteristic of SIADH.