MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) - SEND

A 25-year-old man presented with a 2-month history of thirst and polyuria. He had minimal weight loss and his body mass index was 26 kg/m2 (18-25). He had had sensorineural deafness since childhood. There was a very strong family history of sensorineural deafness and type 2 diabetes mellitus.
Urinalysis showed no ketones.
Investigations:
random plasma glucose18.0 mmol/L
What is the most appropriate next step in management?

• A. test for HFE genotype
• B. genetic testing for maturity-onset diabetes of the young
• C. measurement of glutamic acid decarboxylase antibodies
• D. test for mitochondrial diabetes
• E. water deprivation test to assess posterior pituitary function

A 28-year-old Asian woman was seen in the joint diabetes-antenatal clinic at 16 weeks' gestation. She gave a history of gestational diabetes during her previous pregnancy. She had a strong family history of diabetes mellitus. She was fit and well, and had no symptoms other than slight early morning sickness.
According to NICE guidance (NG3, February 2015) for management of pregnancy, what is the most appropriate way to screen for gestational diabetes in this woman?

• A. haemoglobin A1c
• B. 2-h postprandial plasma glucose
• C. oral glucose tolerance test at 24-28 weeks' gestation
• D. fasting plasma glucose
• E. oral glucose tolerance test as soon as possible

A 33-year-old woman was reviewed in the insulin pump clinic. She had had type 1 diabetes mellitus for 10 years. She had been treated with a continuous subcutaneous insulin infusion 3 years previously, because of frequent hypoglycaemic episodes. She had recently undergone continuous glucose monitoring (see image).

Investigations:
haemoglobin A1c43 mmol/mol (20-42)
What is the most likely cause of the blood glucose trace seen between 08.00 h and 10.00 h?

• A. overcorrection of hypoglycaemia
• B. dawn phenomenon
• C. inadequate mealtime insulin bolus
• D. blocked infusion set
• E. inadequate basal insulin rate

An 18-year-old man with cystic fibrosis was referred to clinic. Over recent months his lung function had deteriorated and he had lost weight. He was being treated for a chest infection at the time of the consultation.
Investigations:
oral glucose tolerance test (75 g):
fasting plasma glucose8.2 mmol/L (3.0-6.0)
2-h plasma glucose13.5 mmol/L (<7.8)
What is the most appropriate management?

• A. start sitagliptin
• B. start gliclazide
• C. repeat oral glucose tolerance test after chest infection has resolved
• D. restrict refined carbohydrate intake
• E. start insulin

A 55-year-old man with mild polyuria and tiredness was seen on a renal ward. He had had a living-related kidney transplant 6 months previously. He had good graft function while being treated with prednisolone 5 mg daily, mycophenolate mofetil 1 g twice daily and tacrolimus 3 mg twice daily. He was also taking atenolol 50 mg daily and simvastatin 40 mg daily.
Investigations:
haemoglobin A1c75 mmol/mol (20-42)
random plasma glucose18.0 mmol/L
Which drug is most likely to be responsible for his diabetes of new onset?

• A. prednisolone
• B. atenolol
• C. tacrolimus
• D. simvastatin
• E. mycophenolate mofetil