Endocrine – Thyroid/DM cases – KFP public report review 2016-2024 topics in exam

Endocrinology – Osteoporosis

1. Acute Onset of Upper-Back Pain and Osteoporosis

• Diagnosis of Osteoporosis from Lateral Spinal X-ray
• Initial Investigations for Osteoporosis
• Non-Pharmacological Management Strategies
  • What Candidates Did Well:
    • Identified osteoporosis and appropriate initial investigations
  • What Candidates Did Poorly:
    • Provided pharmacological advice or non-specific advice instead of non-pharmacological strategies

2. Osteoporosis in an Older Male Patient

• Medical Heading: Geriatrics, Endocrinology
• Key Topics:
  • Causes of osteoporosis in males
  • Appropriate investigations
  • Medication management
• Candidate Performance:
  • Common errors included gender-specific treatment errors and non-specific causative factors
• Improvement Areas:
  • Focus on gender-appropriate management strategies
  • Specific risk factors for osteoporosis in males, such as alcohol intake and medication side effects

Endocrinology – Thyroid Disorders

1. Hypothyroidism Symptoms and Complications

• Key Topics Discussed:
  • Appropriate investigations for hypothyroidism
  • Pharmacological management
  • Investigation of new symptoms
• Candidate Performance:
  • Errors in pharmacological dosing and management
• Improvement Areas:
  • Precise pharmacological management of hypothyroidism, including dosing
  • Thorough investigation of new symptoms

2. Post-Partum Thyroiditis

• Key Topics:
  • Management of post-partum thyroid issues
• Candidate Performance:
  • Challenges in diagnosing and choosing correct investigations
• Improvement Areas:
  • Focused on specific management strategies for thyroiditis
  • Enhancing understanding of post-partum endocrine disorders

3. Asymptomatic Neck Swelling Thought to be a Thyroid Nodule

• Key Medical Subject: Endocrinology
• Topic Discussed:
  • History elements suggesting possible thyroid malignancy
  • Initial investigations for thyroid nodule
• What Candidates Did Well:
  • Identified elements of the history relevant to thyroid malignancy
• What Candidates Did Poorly:
  • Provided later-stage investigations rather than initial ones
  • Failed to understand the time sequence of investigations

4. Tender Goitre

• Topic Discussed:
  • Differential diagnoses and management of an acutely tender goitre
• Candidates Did Well On:
  • Identifying immediate management priorities
• Improvement Areas:
  • Selection of specific tests that help differentiate causes of an acutely tender goitre
  • Focusing on managing pain and tenderness effectively

Endocrinology – Diabetes Management

1. Diabetes and Palliative Care for Metastatic Cancer

• Insight:
  • The importance of individualized care, focusing on non-pharmacological strategies for diabetes management and anxiety in palliative care
• Strengths:
  • Tailoring management plans to the patient’s overall context, especially in palliative settings
• Improvements:
  • Recognize the importance of quality of life in palliative care decisions
  • Avoid generic or life-prolonging interventions that may not align with patient wishes

2. Diabetes Management

• Transitioning to Insulin Use
• Self-Administration of Insulin
• Diabetic Charcot Foot
  • Insight:
    • Early identification and management of Charcot foot to prevent further complications
  • Strengths:
    • Diagnosis and initial management strategies, including patient education on foot care
  • Improvements:
    • Improve knowledge on diabetic foot care
    • Address barriers to accessing medical treatment

3. Annual Diabetes Health Assessment and Family Planning

• Key Topics Discussed:
  • Examination findings
  • Investigations
  • Family planning advice
• Candidate Performance:
  • General, non-specific advice not addressing patient concerns
• Improvement Areas:
  • Tailored advice based on diabetes management and specific patient concerns about family planning

4. Type 2 Diabetes Management

• Key Topics:
  • Assessment and optimization of diabetes management
• Candidate Performance:
  • Failure to adjust medication regimens correctly
  • Address non-adherence issues
• Improvement Areas:
  • Effective diabetes management strategies
  • Addressing patient adherence to treatment plans

5. Diabetes and Acute Illness

• Key Topics:
  • Pharmacological management of a diabetic patient presenting with gastroenteritis
  • Adjustment of diabetes management post-acute episode
• Candidate Performance:
  • Generalized approaches to gastroenteritis management without specific attention to the diabetic context of the patient
• Improvement Areas:
  • Tailored management of acute illnesses in patients with chronic conditions like diabetes
  • Specific adjustments to medication regimens based on clinical outcomes

6. Diabetic Review and Complication Management

• Medical Heading: Endocrinology, Diabetes Management
• Key Topics:
  • Identifying diabetic complications
  • Medication complication awareness
  • Non-lifestyle management strategies
• Candidate Performance:
  • Misinterpretation of the scenario, leading to irrelevant answers or focus on diabetes complications instead of medication impacts
• Improvement Areas:
  • Enhance interpretation of diabetic management scenarios
  • Focus specifically on medication complications and non-lifestyle interventions

7. Gestational Diabetes

• Medical Heading: Obstetrics and Endocrinology, managing diabetes in pregnancy
• Candidates Did Well On:
  • Focusing on specific diabetes management in pregnancy
  • Addressing Vitamin D deficiency according to guidelines
• Improvement Areas:
  • Ensuring management strategies are specifically tailored to gestational diabetes and not general diabetes management

Endocrinology – Other Endocrine and Metabolic Disorders

1. Adrenal Insufficiency Presentation

• Medical Heading: Endocrinology
• Key Topics:
  • Diagnosis of adrenal insufficiency
  • Interpreting related symptoms and test results
  • Acute shock management
• Candidate Performance:
  • Some candidates overlooked adrenal insufficiency signs
  • Focusing on less likely diagnoses or failing to propose specific acute management steps for adrenal crisis
• Improvement Areas:
  • Improve recognition of adrenal insufficiency signs and symptoms
  • Develop urgent management strategies for adrenal crisis, including emergency steroid administration

2. Weight Gain

• Key Topics:
  • Diagnosis and management of unexplained weight gain
  • Consideration of medication effects
• Candidate Performance:
  • Struggled to prioritize presenting symptoms over past medical history
  • Incorrect diagnoses
• Improvement Areas:
  • Focus on symptom-based assessment
  • Interpretation of diagnostic results

3. Weight Loss, Amenorrhea, and Diarrhea

• Specifics:
  • While broad ranges of differential diagnoses were provided, some candidates focused too narrowly on similar conditions or unlikely initial differentials
• Improvement Areas:
  • Broaden clinical reasoning to consider a wide range of plausible diagnoses
  • Focus on those most likely given the patient’s symptoms and history

4. Weight Loss Assistance and Management Post-Gastric Bypass

• Key Topics Discussed:
  • Weight loss management options
  • Initial investigations post-gastric bypass
• Candidate Performance:
  • Limited knowledge of current guidelines
  • Failure to address key features of the patient’s history
• Improvement Areas:
  • Broaden knowledge on weight management strategies
  • Tailor management to the patient’s specific clinical context

5. Turner Syndrome

• Key Areas:
  • Interpreting clinical information (parental height, growth chart) to make a diagnosis of Turner syndrome
  • Arranging appropriate initial investigations, particularly the karyotype
  • Providing advice on confidentiality in adolescent consultations, considering Gillick competence
• Common Errors:
  • Describing the condition without a specific diagnosis (e.g., ‘delayed puberty’, ‘primary amenorrhoea’)
  • Overlooking the importance of a karyotype in initial investigations
  • Providing answers unrelated to confidentiality or incorrectly assessing Gillick competence