Free SEND Questions Attempt

A 55-year-old dental nurse was referred for bone densitometry after sustaining a non-displaced fracture of the femur after falling down a step. She had experienced no other fractures. Her only medical problem was long-standing anaemia of unknown cause. The only family history was of persistent dental abscesses affecting her father. She had three children who were well. She was taking no medication.

Examination was normal.

Investigations:

haemoglobin102 g/L (115–165)

MCV85 fL (80–96)

white cell count6.0 ? 109/L (4.0–11.0)

platelet count245 ? 109/L (150–400)

erythrocyte sedimentation rate25 mm/1st h (<30)

serum creatinine85 µmol/L (60–110)

serum corrected calcium2.40 mmol/L (2.20–2.60)

serum alkaline phosphatase56 U/L (45–105)

DXA scan spine (L2–L4)T score +5.8

DXA scan total hipT score +5.4

What is the most likely diagnosis?

A 76-year-old man with a 17-year history of type 2 diabetes mellitus attended for his annual review. Comparison of his retinal screening report with the previous year’s report showed that his visual acuity was unchanged at 6/9 in both eyes. The previous year’s right eye retinal image had been reported as ‘pre-proliferative retinopathy’, whereas this year’s was reported as ‘pre-proliferative retinopathy with maculopathy’.

What is the most appropriate next step?

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 (18–25).

Investigations:

haemoglobin A1c56 mmol/mol (20–42)

urinary albumin:creatinine ratio1.2 mg/mmol (<3.5)

Over the years her haemoglobin A1c concentration had varied between 58 and 69 mmol/mol. She had impaired awareness of hypoglycaemia and experienced approximately two severe hypoglycaemic events per year. She was worried about the risk of severe congenital malformations in her baby.

To what extent will the average risk of severe congenital malformation be increased in infants born to this mother with pregestational diabetes?

A 17-year-old Caucasian girl presented with primary amenorrhea.

On examination, her body mass index was 21 kg/m2 (18–25). Her body habitus was normal and she had appropriate breast development. There was no hirsutism or acne.

Investigations:

serum oestradiol<180 pmol/L (200–400)

serum testosterone31.7 nmol/L (0.5–3.0)

serum follicle-stimulating hormone4.0 U/L (2.5–10.0)

serum luteinising hormone6.0 U/L (2.5–10.0)

What is the most likely diagnosis?