MRCPUK SEND - Endocrinology and Diabetes (Specialty Certificate Examination) SEND Exam Questions in PDF

Carbimazole is routinely used in the management of thyroid disease. What does carbimazole inhibit?

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 33-year-old woman, who was 9 weeks into her first pregnancy, was admitted with prolonged vomiting and secondary dehydration. She had lost 6 kg in weight since becoming pregnant. There was a strong family history of thyroid disease: two sisters were hypothyroid and one brother had required radioactive iodine for Graves’ disease.

On examination, she had a smooth, small goitre. Her pulse was 94 beats per minute and her blood pressure was 104/42 mmHg. There was a tremor of the outstretched hands. Urinalysis was normal.
Investigations:

-serum sodium143 mmol/L (137–144) serum potassium4.4 mmol/L (3.5–4.9) serum creatinine105 µmol/L (60–110)
-serum thyroid-stimulating hormone (TSH)<0.01 mU/L (0.4–5.0) serum free T424.0 pmol/L (10.0–22.0)
-serum free T311.0 pmol/L (3.0–7.0)

A TSH receptor antibody concentration was awaited.
In addition to rehydration, what is the most appropriate next step in the management of her abnormal thyroid function?

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 34-year-old woman with a 21-year history of type 1 diabetes mellitus had started treatment with subcutaneous insulin pump therapy 18 months previously. Her haemoglobin A1c before starting pump therapy was 77 mmol/mol (20–42) and she had experienced severe hypoglycaemic events without warning symptoms over the previous 4 years.

At review in clinic, she reported continuing episodes of severe hypoglycaemia without warning symptoms despite regular monitoring and advice from her insulin pump nurse specialist.
On examination, her blood pressure was 134/80 mmHg and fundoscopy revealed moderate background diabetic retinopathy. Examination of the feet revealed strong, palpable pedal pulses and early evidence of sensory neuropathy.

Investigations:
-estimated glomerular filtration rate (MDRD)24 mL/min/1.73 m2 (>60) haemoglobin A1c56 mmol/mol (20–42)
-24-h urinary total protein2.3 g (<0.2)

What is the most appropriate next step in management?