Free SEND Exam Braindumps
SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 96–100 (page: 21)

A 46-year-old man of European descent was reviewed in the diabetes clinic. He had type 2 diabetes mellitus, which had been diagnosed 6 months previously. He had been symptom free and was a non-smoker but had a family history of cardiovascular disease. He exercised regularly and had managed to lose 8 kg .
On examination, his blood pressure was 148/76 mmHg, his weight was 76 kg and his body mass index was 24 kg/m2 (18–25).

Investigations:
-urinary albumin:creatinine ratio0.6 mg/mmol (<2.5) serum cholesterol5.6 mmol/L (<5.2)
-serum HDL cholesterol0.90 mmol/L (>1.55) fasting serum triglycerides2.20 mmol/L (0.45–1.69)

According to NICE guidelines (CG181, July 2014), what is the most appropriate management of his lipid profile?

A 62-year-old man was referred from the infectious diseases clinic. He had HIV infection and was taking treatment that included thymidine analogue nucleoside reverse transcriptase inhibitors. He had developed considerable loss of limb and gluteal subcutaneous fat. He had complained recently of polyuria and polydipsia and was found to have a fasting plasma glucose of 8.3 mmol/L (3.0–6.0).
What is the most appropriate treatment for his diabetes mellitus?

A 27-year-old woman presented with a 6-month history of amenorrhoea and low mood. She complained of headaches but no visual disturbance. Her past medical history included anorexia nervosa but her current weight was stable.
On examination, her body mass index was 20.2 kg/m2 (18–25). Routine physical examination was normal and there was no galactorrhoea. Visual fields were full to confrontation.

Investigations:
-serum cortisol (09.00 h)320 nmol/L (200–700)
-short tetracosactide (Synacthen®) test (250 micrograms): serum cortisol (30 min after tetracosactide)630 nmol/L (>550) serum oestradiol200 pmol/L (200–400)
-plasma follicle-stimulating hormone2 U/L (2.5–10.0) plasma luteinising hormone4 U/L (2.5–10.0)
-serum prolactin1001 mU/L (<360) serum free T418.0 pmol/L (10.0–22.0)
-serum ?-human chorionic gonadotropin<5 U/L (<5)

What is the most appropriate next step in management?

A 32-year-old woman with a recurrent history of Graves’ thyrotoxicosis was being considered for radioiodine treatment. However, she wanted to conceive again at some stage and asked how soon she could become pregnant.
After what minimum interval would it be safe for her to conceive again?

A 73-year-old man with type 2 diabetes mellitus was referred to the outpatient clinic. He had a history of microalbuminuria and hypertension. He was taking ramipril, amlodipine and metformin.

On examination, his blood pressure was 125/75 mmHg. Investigations:
haemoglobin A1c57 mmol/mol (20–42)

What additional drug is most likely to prevent glomerular filtration rate decline?