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SEND – SEND - Endocrinology and Diabetes (Specialty Certificate Examination)

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Showing 4–6 of 10 questions

Question 4

A 32-year-old man presented with persistent thirst. He had a past history of polydactyly, which had been corrected surgically in infancy. His family had remarked about his recent weight gain. His only concern was of blurring of vision and difficulty reading. His father and paternal grandfather had each developed type 2 diabetes mellitus when aged 41 and 56 years, respectively.

His body mass index was 34 kg/m2 (18–25). Urinalysis showed glucose 2+, ketones 1+.

Investigations:

serum sodium 142 mmol/L (137–144)

serum potassium 3.8 mmol/L (3.5–4.9)

serum chloride 105 mmol/L (95–107)

serum urea 5.0 mmol/L (2.5–7.0)

serum creatinine 90 µmol/L (60–110)

haemoglobin A1c 91 mmol/mol (20–42)

random plasma glucose 11.3 mmol/L

ultrasound scan of kidneys normal

What is the most likely underlying diagnosis?

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  • ○

    Bardet–Biedl syndrome
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    monogenic diabetes caused by a mutation in the glucokinase gene
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    monogenic diabetes caused by a mutation in the HNF-1? gene
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    Prader–Willi syndrome
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    type 2 diabetes mellitus

Question 5

An 18-year-old woman was referred by her general practitioner for further investigation of “funny turns” during which she developed palpitations, sweating, tremor, hunger, anxiety and paraesthesiae; all of these symptoms were relieved immediately by a sugary drink. She was otherwise well and was not taking any regular medication. There was a family history of type 1 diabetes mellitus. A spontaneous hypoglycaemic episode had not been captured and she was admitted to the diabetes/endocrine ward for a 72-hour fast. Her renal function was normal.

After a 12-hour fast she experienced her typical symptoms. Urinalysis showed no urinary ketones.

Investigations after 12-h fast:

fasting plasma glucose 2.0 mmol/L (3.0–6.0)

plasma insulin 56 pmol/L (<21 after hypoglycaemia)

serum C-peptide 514 pmol/L (180–360)

What is the most appropriate next step in management?

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  • ○

    coeliac axis angiography
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    MR scan of abdomen and pelvis to localise a mesenchymal tumour producing insulin-like growth factor 2
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    MR scan of pancreas to localise an insulinoma
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    obtain a careful history looking for access to exogenous insulin

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    request a urinary sulphonylurea screen on sample obtained during the fast
Question 6

A 35-year-old woman with a 12-year history of type 1 diabetes mellitus was reviewed in the multidisciplinary pump clinic, because her diabetes was treated with an insulin pump. She had a group 2, C1 lorry-driving licence.

Specific driving-related questioning showed that she kept fast-acting carbohydrate in her vehicles and she reported good hypoglycaemic warnings. Data downloaded from her pump indicated significant variability in her blood glucose readings with few results below 2 mmol/L. She declared that this happened occasionally and she was able to explain the events.

According to implementation by the UK of the Third European Union Directive on driving, what is the most appropriate advice?

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  • ○

    her licence must be surrendered immediately until further assessment
  • ○

    she can continue to drive

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    she must appear before a Driver and Vehicle Licensing Agency-accredited diabetes specialist for assessment within 1 month
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    she must surrender her licence for 6 months
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    she should stop driving voluntarily until blood glucose levels increase