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MRCPUK SEND Exam Syllabus Topics:

MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:

Question 1

A 42-year-old policewoman presented with thirst, polyuria and tiredness of 3 months' duration. She gave a family history of thyrotoxicosis.
On examination, her pulse was 108 beats per minute and her blood pressure was 150/70 mmHg. She had a fine tremor and diffuse thyroid enlargement. She also had mild proptosis.
Investigations:
haemoglobin146 g/L (115-165)
platelet count164 ? 109/L (150-400)
serum sodium143 mmol/L (137-144)
serum creatinine135 umol/L (60-110)
serum corrected calcium3.60 mmol/L (2.20-2.60)
serum thyroid-stimulating hormone<0.02 mU/L (0.4-5.0)
serum free T431.9 pmol/L (10.0-22.0)
serum free T315.6 pmol/L (3.0-7.0)
What is the most appropriate next investigation?

A. serum phosphate
B. fine-needle aspiration of thyroid
C. isotope bone scan
D. 24-h urinary calcium
E. plasma parathyroid hormone

Question 2

A 16-year-old Caucasian girl presented with a 4-year history of facial hair growth, acne and secondary amenorrhoea.
On examination, her body mass index was 20 kg/m2 (18-25). Her gums and palmar creases were pigmented. Facial hair was evident on her upper lip and chin, and terminal hair was evident on her chest and abdomen. Her Ferriman-Gallwey score was 25. She had acne affecting her face and back.
Investigations:
serum dehydroepiandrosterone sulphate15 umol/L (3-12)
serum androstenedione12.2 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone120 nmol/L (1-10)
serum testosterone6.0 nmol/L (0.5-3.0)
serum sex hormone binding globulin18 nmol/L (40-137)
What treatment is likely to be of most benefit?

A. fludrocortisone
B. cyproterone acetate
C. flutamide
D. hydrocortisone
E. metformin

Question 3

A 54-year-old man on the neurosurgery unit developed hyponatraemia 3 days after presenting with a significant head injury. His Glasgow coma score (GCS) had been 6 on admission.
On examination, his GCS was 12. His blood pressure was 124/84 mmHg. There was no
oedema.
Investigations:
serum sodium118 mmol/L (137-144)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine72 umol/L (60-110)
random serum cortisol (08.00 h on day of review)480 nmol/L
serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0)
random urinary sodium60 mmol/L
What is the most appropriate interpretation of these data?

A. the urinary sodium concentration is diagnostic of cerebral salt wasting
B. a short tetracosactide (Synacthen@) test (250 micrograms) is required to exclude secondary hypoadrenalism
C. the diagnosis would be helped by measurement of plasma vasopressin concentration
D. they are consistent with syndrome of inappropriate antidiuresis
E. intravascular volume depletion

Question 4

A 33-year-old woman was seen for diabetes review 2 months after her first pregnancy. Diabetes mellitus had been diagnosed at 18 weeks' gestation. She had experienced no symptoms; routine urinalysis had shown glucose 4+, with no ketones, and her fasting blood glucose concentration was 6.2 mmol/L (3.0-6.0), rising to 13.5 mmol/L (<7.8) in a 75-g oral glucose tolerance test. She had been treated with insulin during the pregnancy, and stopped after delivery. Her mother and maternal aunt had been treated for type 2 diabetes mellitus, and a maternal uncle for type 1 diabetes. Her body mass index was 23.7 kg/m2 (18-25).
Without insulin she remained well, with no osmotic symptoms, no weight loss and no ketosis.
Investigations:
fasting plasma glucose8.4 mmol/L (3.0-6.0)
haemoglobin A1c68 mmol/mol (20-42)
oral glucose tolerance test (75 g):
fasting plasma glucose7.9 mmol/L (3.0-6.0)
2-h plasma glucose13.8 mmol/L (<7.8)
serum insulin72 pmol/L (<186)
serum C-peptide945 pmol/L (180-360)
A trial of therapy with gliclazide 40 mg once daily led to a significant improvement in her blood glucose.
What is the most likely cause of her diabetes?

A. type 1 diabetes mellitus
B. maturity-onset diabetes of the young caused by HNF-1? mutation
C. latent autoimmune diabetes in adulthood
D. type 2 diabetes mellitus
E. maturity-onset diabetes of the young caused by glucokinase mutation

Question 5

A 15-year-old boy was referred by the school nurse because she was concerned about his weight. There was no past history of note. He was not taking any medication. His height was 1.61 m and he weighed 70.5 kg.
Investigations: growth chartsee image

What is the most likely diagnosis?

A. leptin deficiency
B. simple obesity
C. Prader-Willi syndrome
D. growth hormone deficiency
E. Cushing's disease

Solutions: