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What is the most appropriate next step in management?
A 17-year-old boy with type 1 diabetes mellitus was admitted with diabetic ketoacidosis precipitated by a recent viral illness. Investigations on admission: random plasma glucose15.0 mmol/L arterial blood gases, breathing air: pH7.07 (7.35C7.45) H+85 nmol/L (35C45) Investigations after initial treatment with fluids, insulin and potassium 7 h after admission: random...
To what extent will the average risk of severe congenital malformation be increased in infants born to this mother with pregestational diabetes?
A 32-year-old woman, with a 22-year history of type 1 diabetes mellitus, was seen in a pre-pregnancy diabetes clinic. She was a primigravida. On examination, she had early background retinopathy, her blood pressure was 128/68 mmHg, and her body mass index was 29.7 kg/m2 (18C25). Investigations: haemoglobin A1c56 mmol/mol (20C42)...
What is the most appropriate next investigation?
A 67-year-old woman with type 2 diabetes mellitus presented to the foot clinic with an ulcer at the plantar aspect of her fifth left toe. The ulcer probed to bone but there were no signs of inflammation. There had been a little improvement during 6 weeks of podiatric treatment, but...
What is the most likely cause of the hypercalcaemia?
A 55-year-old woman presented with a 3-week history of nausea and vomiting. Her only medical complaints were frequent dyspepsia, for which she was taking indigestion tablets, and asthma for which she was taking a salbutamol inhaler as required. On examination, there was no evidence of lymphadenopathy, her chest was clear...
What is the chief product of the Sertoli cell?
A 19-year-old man presented with late development of his pubic and axillary hair. He was otherwise well and was not taking any medication. His serum testosterone concentration had been normal on two previous occasions. On examination, he now had post-pubertal secondary sexual characteristics. He had 15C20 mL testes. Investigations: serum...
What is the most likely diagnosis?
30-532 Results from an MR scan of pituitary are shown (see image). What is the most likely diagnosis?A . autoimmune (lymphocytic) hypophysitisB . craniopharyngiomaC . non-functioning pituitary adenomaD . psychogenic polydipsiaE . Rathke’s cleft cystView AnswerAnswer: A
What is the most important next step in management to prevent further crises?
A 34-year-old woman with Addison’s disease reported four adrenal crises over the preceding 6 months, requiring hospital admission and intravenous administration of hydrocortisone. At outpatient follow-up, she was taking hydrocortisone 15 mg in the morning and 10 mg at midday, and fludrocortisone 50 micrograms daily. What is the most important...
What dose of radioiodine is most appropriate in uncomplicated Graves’ disease?
A 26-year-old woman presented with recurrent Graves’ disease. After discussing the treatment options, she chose radioiodine. What dose of radioiodine is most appropriate in uncomplicated Graves’ disease?A . 100C200 MBqB . 400C600 MBqC . 700C900 MBqD . 1000C1200 MBqE . 1400C1600 MBqView AnswerAnswer: B
What are the most important tests for monitoring safe replacement?
A 55-year-old male-to-female transsexual was reviewed in clinic. She lived as a woman but had not undergone gender reassignment surgery. She was treated with cyproterone acetate 50 mg twice daily and estradiol 2 mg twice daily. What are the most important tests for monitoring safe replacement?A . lipid profile and...
What is the most appropriate next step in management?
A 48-year-old man presented with gynaecomastia. His serum oestradiol was increased and a CT scan of adrenal glands revealed a 13-cm tumour of the left adrenal gland. Further workup showed increased secretion of 17-hydroxyprogesterone, cortisol and androstenedione. A diagnosis of adrenocortical carcinoma was suspected. Investigations: staging CT scan of chest...
