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What is the most likely diagnosis?
A 17-year-old girl was referred to the outpatient clinic with irritability, weight loss and difficulty sleeping. At the age of 4, she had presented with rapid growth, breast development and vaginal bleeding. The results of a gonadotropin-releasing hormone (GnRH) stimulation test performed at that time are given below. serum oestradiolplasma...
What is the most appropriate investigation?
A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin’s lymphoma at the age of 17. What is the most appropriate investigation?A . semen analysisB ....
What force should a monofilament deliver?
A 64-year-old man attended the diabetes clinic for annual review. He complained of very recent tingling in his feet. A monofilament was used to screen for the presence of chronic sensorimotor diabetic peripheral neuropathy. What force should a monofilament deliver?A . 1 gB . 2 gC . 5 gD ....
In what order are responses to hypoglycaemia most likely to occur as blood glucose falls?
A 26-year-old physiologist was seen in the diabetes outpatient clinic. She had type 1 diabetes mellitus of 9 months’ duration, treated with subcutaneous insulin. She asked what symptoms of hypoglycaemia she might experience. In what order are responses to hypoglycaemia most likely to occur as blood glucose falls?A . autonomic,...
What is the most likely diagnosis?
A 17-year-old Caucasian girl presented with primary amenorrhea. On examination, her body mass index was 21 kg/m2 (18C25). Her body habitus was normal and she had appropriate breast development. There was no hirsutism or acne. Investigations: serum oestradiol<180 pmol/L (200C400) serum testosterone31.7 nmol/L (0.5C3.0) serum follicle-stimulating hormone4.0 U/L (2.5C10.0) serum...
What is the most appropriate next step in management according to British Thyroid Association 2014 Guidelines for the Management of Thyroid Cancer?
A 67-year-old woman presented to her general practitioner with a swelling in her neck. It had been present for 4C5 years and had not changed in size during that time. She was completely asymptomatic and remained well. On examination, there was a nodular goitre and no lymphadenopathy. Investigations: serum thyroid-stimulating...
What is the reason for this decision?
A 34-year-old woman presented with palpitations, heat intolerance and a slight tremor. She was 9 weeks into her first pregnancy. She had not had any morning sickness. On examination, her pulse was 100 beats per minute. She had a small uniform goitre but no tremor and no eye signs. Investigations:...
What is the most important diagnosis to consider?
A 20-year-old man presented with a 6-month history of lethargy and weakness. His brother had been found to have adrenal failure at the age of 18. He had two sisters who were well and there was no other family history of endocrine autoimmune disease. On examination, his blood pressure was...
What is the most likely interpretation of her thyroid function test results?
A 36-year-old woman was referred to the endocrine clinic with abnormal thyroid function tests. She gave a 3-year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder. Investigations: serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4C5.0) serum free T429.8 pmol/L (10.0C22.0)...
What is the most appropriate next step in management?
An 18-year-old woman was referred by her general practitioner for further investigation of “funny turns” during which she developed palpitations, sweating, tremor, hunger, anxiety and paraesthesiae; all of these symptoms were relieved immediately by a sugary drink. She was otherwise well and was not taking any regular medication. There was...
