Selected SEND Specialty Certificate Examinations Questions Answers

A 26-year-old woman presented with recurrent Graves’ disease. After discussing the treatment options, she chose radioiodine.

What dose of radioiodine is most appropriate in uncomplicated Graves’ disease?

A 26-year-old woman with type 1 diabetes mellitus was seen in the antenatal diabetes clinic and was 8 weeks pregnant. The father of her child also had type 1 diabetes mellitus. They were concerned that their child might develop type 1 diabetes mellitus.

What is the likelihood of the child developing type 1 diabetes mellitus?

A 56-year-old man presented with a 6-month history of erectile dysfunction. He had noticed a gradual reduction in his frequency of shaving from daily to twice a week. His libido had diminished and he felt that he was not as strong as he once was. He also described general aches and pains. He was a farm worker and had drunk a bottle of vodka daily for several years, but had stopped drinking 2 years previously. He was a non-smoker.

Investigations:

serum urea6.2 mmol/L (2.5–7.0)

serum creatinine89 µmol/L (60–110)

serum albumin40 g/L (37–49)

serum total bilirubin17 µmol/L (1–22)

serum alanine aminotransferase48 U/L (5–35)

serum aspartate aminotransferase37 U/L (1–31)

haemoglobin A1c55 mmol/mol (20–42)

serum cortisol (09.00 h)389 nmol/L (200–700)

serum testosterone0.7 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 prolactin458 mU/L (<360)

serum thyroid-stimulating hormone3.4 mU/L (0.4–5.0)

MR scan of pituitarysee image

What is the most likely explanation of his symptoms?

A 73-year-old man had been attending the diabetes clinic for 6 weeks with an ulcer on his right second metatarsal head. He had been receiving regular podiatry and offloading.

What new feature in the appearance of his foot is most likely to suggest the need to start antibiotics?