AMC MCQ - Australian Medical Council Multiple Choice Questions Renal and Endocrine Disorders Questions and Answers

Question 1

A 22-year-old female with type 1 diabetes presents to the emergency department with confusion, nausea, and vomiting.
Her blood glucose is 28 mmol/L, pH is 7.15, and serum ketones are elevated.
She is tachycardic and hypotensive.
What is the most appropriate initial intravenous fluid for resuscitation?

Accepted Answer

0.9% sodium chloride (Normal Saline)

Answer

0.45% sodium chloride (Half-Normal Saline)

Answer

5% Dextrose in water

Answer

Hartmann's solution (Lactated Ringer's)

Question 2

A 35-year-old woman presents with a 3-month history of weight loss despite an increased appetite, palpitations, and heat intolerance. On examination, she has a fine tremor and a diffusely enlarged, non-tender thyroid gland. Which of the following patterns of thyroid function tests and antibodies would be most consistent with a diagnosis of Graves' disease?

Accepted Answer

Low TSH, High Free T4, High Free T3, Positive TSH Receptor Antibodies (TRAb)

Answer

Low TSH, High Free T4, High Free T3, Positive Thyroid Peroxidase (TPO) antibodies

Answer

High TSH, Low Free T4, Positive Thyroid Peroxidase (TPO) antibodies

Answer

Normal TSH, Normal Free T4, High Thyroglobulin antibodies

Question 3

A 68-year-old man with Stage 4 Chronic Kidney Disease (eGFR 25 mL/min/1.73m²) due to diabetic nephropathy is found to have a haemoglobin of 95 g/L. His iron studies show a ferritin of 80 µg/L and a transferrin saturation (TSAT) of 15%. Other causes of anaemia have been excluded. According to Australian (KHA-CARI/KDIGO) guidelines, what is the most appropriate next step in managing his anaemia?

Accepted Answer

Initiate a trial of intravenous or oral iron therapy.

Answer

Commence an erythropoiesis-stimulating agent (ESA) immediately.

Answer

Administer a blood transfusion to raise haemoglobin above 100 g/L.

Answer

Recheck haemoglobin and iron studies in 3 months.

Question 4

A 40-year-old patient is diagnosed with primary adrenal insufficiency (Addison's disease). Which of the following electrolyte patterns is most characteristically seen in this condition?

Accepted Answer

Hyponatraemia, hyperkalaemia, metabolic acidosis

Answer

Hypernatraemia, hypokalaemia, metabolic alkalosis

Answer

Hyponatraemia, hypokalaemia, metabolic acidosis

Answer

Hypernatraemia, hyperkalaemia, metabolic alkalosis

Question 5

An 80-year-old man with small cell lung cancer is admitted with confusion. His serum sodium is 118 mmol/L. He is clinically euvolaemic. His serum osmolality is low, and his urine osmolality is inappropriately high (>100 mOsm/kg). His renal and thyroid function are normal. Which additional finding would support a diagnosis of SIADH?

Accepted Answer

High urine sodium concentration (>30 mmol/L)

Answer

Low urine sodium concentration (<20 mmol/L)

Answer

Presence of peripheral oedema

Answer

Recent use of diuretic medication

Question 6

A 75-year-old man develops an acute kidney injury (AKI) 48 hours after a hypotensive episode during surgery. His creatinine has risen from 80 µmol/L to 250 µmol/L and he is oliguric. A urinary catheter is in situ and draining freely. Which set of urinary indices would be most suggestive of pre-renal azotaemia rather than established acute tubular necrosis (ATN)?

Accepted Answer

Urine osmolality >500 mOsm/kg, Urine sodium <20 mmol/L, FENa <1%

Answer

Urine osmolality <350 mOsm/kg, Urine sodium >40 mmol/L, FENa >2%

Answer

Eosinophils present in the urine sediment

Answer

Presence of red cell casts in urine microscopy

A 22-year-old female with type 1 diabetes presents to the emergency department with confusion, nausea, and vomiting.Her blood glucose is 28 mmol/L, pH is 7.15, and serum ketones are elevated.She is tachycardic and hypotensive.What is the most appropriate initial intravenous fluid for resuscitation?