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B.

1, 25 dihydroxy vitamin D

C.

Mammography

D.

CA19 9 assay

E.

Urinary protein electrophoresis

A 54 year old man has a blood test for insurance purposes and a calcium is 2.98 mmoL.  Phosphate, albumin and parathyroid hormone are all in the normal range.  He does not recall ever having a urinary stone and is otherwise well.  He does recall that his mother had high calcium.  What investigation shold be perfomed next?

A.

PTHrP assay

B.

24 hour urinary calcium excretion

C.

MRI of the pituitary gland

D.

Serum ACE

E.

CXR

A 58 year old woman presents with a neck swelling.  Examination reveals a multinodular goitre.  She is clinically and biochemically euthyroid.  A radioiodine uptake scan (not shown) shows diffuse uptake except for a predomintant cold nodule in the right lobe of the thyroid.  A fine needle aspirate contains numerous follicular cells but no malignant cells are detected.  What is the best management?

A.

Repeat fine needle aspiration

B.

Right thyroid lobectomy

C.

Total thyroidectomy

D.

Thyroxine therapy

E.

Radioiodine thyroid ablation therapy

A 49 year old woman who is takinig nortriptylline for depression and HRT for hot flushes has a prolactin level of 1900.  Thyroxine and TSH normal, short synacthen test: appropriate ris in cortisol, LH and FSH both slightly low.  What is the most likely reason for the elevated prolactin level?

A.

Pituitary prolacinoma

B.

Chromophobe pituitary adenoma

C.

Depression

D.

Nortriptylline therapy

E.

Hormone replacement therapy

A 56 year old man has had persistently elevated blood pressure.  Clinical examination is unremarkable except for blood pressure of  190/95 mmHg.  Blood test results:

Na140

K3.0

Cl110

Creatinine0.076

Urea4.5

Serum aldosteronehigh

Plasm renin activitylow

What test sould be performed next?

A.

24 hour urinary aldosterone

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