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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 31–35 (page: 8)

A 56-year-old man with a 5-year history of type 2 diabetes mellitus was worried about developing a foot ulcer. Which clinical feature, if present, best predicts the development of a foot ulcer in a patient with diabetes?

A 23-year-old man presented with a history of discomfort with his gender for as long as he could remember. He believed he was transsexual.
What element of further history would most strongly support his self-diagnosis?

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 (7.35–7.45)
-H+85 nmol/L (35–45)
-Investigations after initial treatment with fluids, insulin and potassium 7 h after admission: random plasma glucose4.0 mmol/L serum bicarbonate10 mmol/L (20–28)

At this stage, he was being given infusions of insulin (1 U/h) and glucose 5% (100 mL/h). What is the most appropriate next step in management?

A 56-year-old man was referred urgently by an ophthalmologist after presenting with a 6-month history of deteriorating vision. The patient had a 40 pack-year smoking history. Before his vision problem, he had never visited his general practitioner.

Investigations:
-serum cortisol (09.00 h)389 nmol/L (200–700) serum testosterone8.6 nmol/L (9.0–35.0)
-plasma follicle-stimulating hormone2.1 U/L (1.0–7.0) plasma luteinising hormone2.4 U/L (1.0–10.0)
-serum prolactin896 mU/L (<360)
-serum thyroid-stimulating hormone1.4 mU/L (0.4–5.0) MR scan of pituitarysee image



What is the most likely diagnosis?

An 18-year-old man presented with delayed puberty.
On examination, he had a high arched palate. His sense of smell was intact, and he had a family history of pubertal delay. Kallman’s syndrome was suspected.

Investigations:
-serum testosterone0.3 nmol/L (9.0–35.0)
-serum follicle-stimulating hormone1.0 U/L (1.0–7.0) serum luteinising hormone1.0 U/L (1.0–10.0)
-bone age15 years

What further clinical finding would most strongly support the diagnosis of Kallman’s syndrome?