SEND Exam Preparation Material | Endocrinology and Diabetes (Specialty Certificate Examination)

A 57-year-old man was admitted to hospital with joint pains. He was found to have gout. He had been found to have type 2 diabetes mellitus at the age of 47 years and developed nephropathy 7 years later. He was taking metformin 1 g twice daily, ramipril 5 mg twice daily and gliclazide 80 mg twice daily. The admitting team advised him to take ibuprofen 400 mg three times daily as needed.
On examination, his pulse was 87 beats per minute and his blood pressure was 146/85 mmHg. He had an inflamed right hallux.
Investigations:
serum sodium131 mmol/L (137C144)
serum potassium5.1 mmol/L (3.5C4.9)
serum creatinine156 µmol/L (60C110)
estimated glomerular filtration rate (MDRD)42 mL/min/1.73 m2 (>60)
haemoglobin A1c72 mmol/mol (20C42)
random plasma glucose23.0 mmol/L
What is the most appropriate step in management?

A 72-year-old woman was referred for bone density assessment after sustaining a fracture of her right ankle after a minor fall. She had previously fractured her right wrist after tripping in the street. Her past medical history included occasional angina relieved by glyceryl trinitrate spray and a previous deep venous thrombosis. Her medication comprised aspirin, simvastatin, alendronic acid, and calcium and vitamin D, which she had been taking regularly for 2 years.
Investigations:
DXA scan of spine (L2CL4)T score C2.4
DXA scan of total hipT score C2.8
What is the most appropriate treatment?

A 20-year-old woman with Turner’s syndrome had heard that there was a risk of ovarian cancer associated with Turner’s syndrome. She asked to undergo a pre-emptive oophorectomy.
For what genotype is oophorectomy most likely to be recommended?

A 25-year-old woman presented with a solitary nodule in the right lobe of her thyroid gland.
Investigations:
serum thyroid-stimulating hormone0.45 mU/L (0.4C5.0)
serum free T420.7 pmol/L (10.0C22.0)
The presence of which feature would most increase the likelihood of malignancy?

An 85-year-old woman was referred with a lump in her neck. She had no symptoms of thyroid disease.
On examination, she had a 2 ? 3-cm firm mass at the lower pole in the right thyroid lobe.
Her resting pulse was 90 beats per minute and regular.
Investigations:
serum thyroid-stimulating hormone3.5 mU/L (0.4C5.0)
serum free T415.0 pmol/L (10.0C22.0)
serum free T36.2 pmol/L (3.0C7.0)
anti-thyroid peroxidase antibodies28 IU/mL (<50)
ultrasound scan of thyroidmixed cystic/solid mass with
scattered microcalcifications
fine-needle aspiration biopsyThy 3a
What is the most appropriate next step in her management?