Clin Med
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Case Reports
Severe orthostatic hypotension in a diabetic patient may not be due to diabetic autonomic neuropathy.
This lesson describes an unusual case of a man who was recently diagnosed with type 1 diabetes and who presented with severe orthostatic hypotension. As his diabetes was recent in onset, well controlled, and he had no other signs of microvascular disease, other causes of orthostatic hypotension were sought. His serum and cerebrospinal fluid were strongly positive for Borrelia burgdorferi IgG, suggesting a diagnosis of Lyme neuroborreliosis. Autonomic instability in Lyme, while rare, has been previously reported.
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Both the MRCP(UK) written examinations and the specialty certificate examinations (SCEs) use single-best-answer questions to assess the knowledge and problem-solving skills of physicians in training. Since 1999, specialists and senior trainees have created large banks of questions for these examinations that cover the relevant curricula. ⋯ Each question drafted is subjected to face-to-face peer review and subsequent stages of academic scrutiny before reaching the question bank, and later during the exacting processes of question selection and standard setting. Feedback to question writers at every level of scrutiny helps to support the development of question-writing competence, and the analysis of individual question performance provides some insight into optimal question design.