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Endocrine

A 56 year old man who has type 2 diabetes mellitus undergoes routine physical examination.  Fundoscopy (not shown) reveals several microaneurysms and an occasonal hard exudate.  Which is the best option to prevent blindness in this patient?

A.

Improving glycaemic control.

B.

Improving blood pressure control.

C.

Laser photocoagulation.

D.

Measure urinary microalbumin.

E.

Repeat fundoscopy in 6 months.

A 64 year old woman who has had hypertension and type 2 diabetes, both for 15 years, presents complaining of diplopia.  Physical examination is unremakable except for a right third nerve palsy with sparing of the pupil.  What is the most likely cause of the third neve palsy?

A.

Cavernous sinus thrombosis.

B.

Right midbrain haemorrhage.

C.

Diabetes.

D.

Hypertension.

E.

Myasthenia gravis.

A 79 year has a bone scan.

(hgh signal proximal femora to nerly mid-shaft, high signal in several other places, shown)

What is the most likely explanation for this appearance?

A.

Bilateral hip fractures

B.

Multiple myeloma

C.

Pagets disease

D.

Bony metastases

E.

Osteoporosis

A 64 year old woman develops sudden back pain while lifting two buckets of water.  Plain lateral radiograph of thoracolumbar spine (osteopenia+wedge fracture T12 vertebral body, shown)

Blood tests given:

FBCmild normocytic anaemia, mild lymphopaenia

Calciumnormal

Phospatenormal

Protein mildly low

Albumin low normal

Immunoglbulinsmildly low

IgGlow

Other Ig subclassesmildly low or low normal

DEXA scan:

HipT score -2.0

Lumbar SpineT score -4.0

What is the most appropriate next investigation?

A.

Serum parathyroid hormone

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