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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 21–25 (page: 6)

A 37-year-old woman presented with a 2-year history of increasingly frequent flushing episodes. She described alternating loose bowel motions and constipation. She had also noted menstrual irregularity. She had no respiratory symptoms. She denied headache or chest pain, but complained of palpitations.
On examination, she appeared well. Her blood pressure was 128/82 mmHg. Investigations:
serum thyroid-stimulating hormone0.8 mU/L (0.4–5.0) What is the most appropriate next investigation?

A 47-year-old nuclear physics professor was referred for advice before taking up an overseas position, overseeing the dismantling of a reactor at the site of a recent nuclear accident. She stated that she would face a small risk of being exposed to significant radioactive contamination during her work and was concerned about her future risk of thyroid cancer.
What is the most appropriate advice?

A 19-year-old man was seen in the diabetes clinic. He had lost 2 kg in weight since the diagnosis of diabetes mellitus 18 months previously. At presentation, his body mass index was 33 kg/m2 (18–25), his random plasma glucose was 18.0 mmol/L and his haemoglobin A1c was 56 mmol/mol (20–42). He was taking gliclazide, and metformin had been added later. His father and grandfather had developed diabetes mellitus during their twenties.
Investigations:

haemoglobin A1c56 mmol/mol (20–42) serum C-peptide301 pmol/L (180–360) anti-glutamic acid decarboxylase (GAD) antibodiesnegative

What is the most likely diagnosis?

A 48-year-old man with an 8-year history of type 2 diabetes mellitus was referred because of poor glycaemic control. He had a history of myocardial infarction complicated by previous congestive cardiac failure. His current medication comprised metformin 850 mg three times daily and gliclazide 80 mg once daily. He had gained weight and his body mass index was 31 kg/m2 (18–25).

Investigations:
serum sodium143 mmol/L (137–144) serum potassium4.4 mmol/L (3.5–4.9) serum creatinine136 µmol/L (60–110) haemoglobin A1c74 mmol/mol (20–42)
According to NICE guidelines (CG87, May 2009), what is the most appropriate immediate next step in management to improve his glycaemic control?

A 48-year-old man presented with an infected ulcer, measuring 2 ? 1 cm, over the right first metatarsal head, with surrounding cellulitis. He had no previous history of diabetes mellitus but had been told by his general practitioner some years previously that his blood glucose was ‘borderline’.
On examination, his temperature was 37.4°C, his blood pressure was 158/92 mmHg and his body mass index was 31.5 kg/m2 (18–25). His foot pulses were easily palpable but he had a sensory neuropathy.

Investigations:
random plasma glucose16.4 mmol/L haemoglobin A1c81 mmol/mol (20–42)

What is the most appropriate treatment for his hyperglycaemia?