A 17-year-old boy with a 10-year history of type 1 diabetes mellitus was admitted with

diabetic ketoacidosis after a night of binge drinking.

He was treated appropriately with a fixed-rate intravenous insulin infusion and intravenous sodium chloride 0.9%.

Twenty-four hours after admission, he was eating and drinking normally. He was taking his usual doses of subcutaneous insulin and his urinary ketones were undetectable.

Investigations (6 hours previously):

venous blood gases, breathing air:

PO25.6 kPa

PCO23.8 kPa

pH7.29

bicarbonate16 mmol/L

base excessC1 mmol/L

lactate1.1 mmol/L

What is the likely most cause of these results?

Reveal Solution Hide Solution

A 46-year-old Afro-Caribbean man with sarcoidosis was found to have hypercalcaemia and was treated with prednisolone 20 mg/day. Within 3 weeks his serum calcium had fallen to within the reference range.

How do glucocorticoids reduce serum calcium in sarcoidosis?

Reveal Solution Hide Solution

A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin’s lymphoma at the age of 17.

What is the most appropriate investigation?

Reveal Solution Hide Solution

A 55-year-old male-to-female transsexual was reviewed in clinic. She lived as a woman but had not undergone gender reassignment surgery. She was treated with cyproterone acetate 50 mg twice daily and estradiol 2 mg twice daily.

What are the most important tests for monitoring safe replacement?

Reveal Solution Hide Solution

A 17-year-old girl presented with primary amenorrhoea. She had grown and developed normally. There was no history of galactorrhoea or hirsutism.

On examination, her height was 1.69 m, her weight was 68.3 kg, and her body mass index was 23.9 kg/m2 (18C25). She had stage 5 breast development and stage 5 pubic hair. Her visual fields were full to confrontation.

Investigations:

serum cortisol (09.00 h)416 nmol/L (200C700)

serum oestradiol51 pmol/L (200C400)

serum follicle-stimulating hormone0.8 U/L (2.5C10.0)

serum luteinising hormone1.2 U/L (2.5C10.0)

serum thyroid-stimulating hormone1.2 mU/L (0.4C5.0)

serum free T415.6 pmol/L (10.0C22.0)

What is the most appropriate next investigation?

Reveal Solution Hide Solution

A 67-year-old woman with type 2 diabetes mellitus presented to the foot clinic with an ulcer at the plantar aspect of her fifth left toe. The ulcer probed to bone but there were no signs of inflammation. There had been a little improvement during 6 weeks of podiatric treatment, but there was some concern about possible osteomyelitis. An X-ray of toe 4 weeks

previously had been normal.

What is the most appropriate next investigation?

Reveal Solution Hide Solution

A 25-year-old woman presented at 28 weeks’ gestation after a screening 75-g oral glucose tolerance test, which had shown a fasting plasma glucose of 5.6 mmol/L (3.0C6.0) and a 2-h plasma glucose of 9.8 mmol/L (<7.8). She had a family history of type 2 diabetes mellitus and a pre-pregnancy body mass index of 36 kg/m2 (18C25). Home blood glucose monitoring had shown persistently raised blood glucose despite dietary modification. She refused insulin because of needle phobia and was concerned about drug exposure to her unborn child.

The use of what hypoglycaemic therapy is acceptable in this situation?

Reveal Solution Hide Solution