A previously fit and well 34 year old lady unfortunately experiences severe postpartum haemorrhage when giving birth to her first child. She goes into hypovolaemic shock, which her obstetric team struggles to manage. Eventually she is stabilised and is discharged from hospital. She finds herself unable to lactacte, and over time experiences amenorrhoea. Six months later she presents and on examination she has ptosis, miosis and anhidrosis. What is the most likely cause of her symptoms?

A Meningitis

B Empty Sella Synrome

C Multiple sclerosis

D Pituitary necrosis

E Pituitary adenoma

A 41 year old gentleman with no notable past medical history presents to GP feeling tired all the time. He has pain in his second and third fingers. He also notes that he has found difficulty achieving and maintaining an erection. He felt that this was due to his low mood, which was made worse by his brother dying last year, of ‘an enlarged heart’. On examination he has hepatomegaly, eleven spider naevi, leukonychia and appears tanned. On initial bloods, his ALT is 121 (normal <40), ALP is 141 (normal 40-129). What would be the most useful initial investigation in diagnosing the cause of this presentation?

A Fasting blood sugar

B Serum ferritin

C Thyroid function tests

D Abdominal ultrasound

E Serum cortisol

A 55 year old man has presented to his GP wondering if he could have his blood pressure checked. He is found to have a blood pressure of 180/99. On routine bloods, his U&Es show: Sodium 145 (normal 135-145), Potassium 2.8 (normal 3.5-5). Aldosterone levels are elevated. You refer him to endocrinology. The gentleman comes back to see you six months later to thank you for your help. He states he was given a medicine called ‘spironolactone’ and had surgery, which removed a ‘canary yellow’ tumour. What is the likely cause of this gentleman’s symptoms?

A Cushing’s Disease

B Secondary hyperaldosetronism

C Conn’s Syndrome

D Renal artery stenosis

E Congenital adrenal hyperplasia

A 69 year old man is currently undergoing treatment for lung cancer, which had been responding well to chemotherapy. He has presented for follow up bloods, which have noted: Na 121 (normal 135-145), Potassium 4.9 (normal 3.5-4.5), Urea 8.6 (normal 2.5-7.9). Thyroid function is normal, whilst urine osmolality is elevated. His blood pressure is normal and he is not fluid overloaded. What is the most likely cause of this pattern?

A SIADH

B Diabetes insipidus

C Renal failure

D Vomiting

E Nephrotic syndrome

A 53 year old woman has presented to GP complaining that her eyes look unusual, compared to photos from when she was younger. Her vision itself is no worse. On examination she has chemosis, exophthalmos, lid lag, lid retraction and ophthalmoplegia. She feels well in herself and is apyrexial. What is the most appropriate initial investigation to undertake?

A Chest X Ray

B Orbital ultrasound

C C reactive protein

D Thyroid function tests

E Lyme serology

A 31 year old lady has presented to you with increased urinary frequency and muscle weakness. Her past medical history includes severe depression, for which she takes sertraline. On routine bloods her calcium is 2.9 (normal 2.25-2.5). Chest X Ray and urinalysis are normal. What is the most likely cause of her hypercalcaemia?

A Lung cancer

B Thyrotoxicosis

C Iatrogenic

D Primary hyperparathyroidism

E Secondary hyperparathyroidism