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MRCPUK SEND Exam Syllabus Topics:

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

1. A 62-year-old woman with persistent hypertension attended the clinic for review. She had no previous medical history of note and was taking amlodipine, ramipril, bendroflumethiazide, spironolactone and doxazosin. Her blood pressure was raised at 160/100 mmHg.
Investigations:
serum sodium138 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
A blood test for renin and aldosterone concentration was being considered.
For what minimum period should spironolactone be discontinued before this test?

A) 6 weeks
B) 2 weeks
C) 1 week
D) 8 weeks
E) 72 h

2. A 49-year-old woman presented with a slowly enlarging lump in her neck.
On examination, there was a 3.5-cm firm nodule in the left lobe of the thyroid gland, with no associated lymphadenopathy.
Investigations:
serum thyroid-stimulating hormone<0.05 mU/L (0.4-5.0)
serum free T426.0 pmol/L (10.0-22.0)
serum free T38.6 pmol/L (3.0-7.0)
An ultrasound scan showed an enlarged thyroid gland, with small nodules throughout. There was a larger hypoechoic 3.3-cm nodule with increased intranodular vascularity in the lower pole of the left lobe, with no associated lymphadenopathy.
What is the most appropriate management?

A) radioactive iodine treatment
B) fine-needle aspiration of the nodule
C) isotope uptake scan
D) partial thyroidectomy
E) core biopsy of the thyroid nodule

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

4. A 56-year-old man was referred urgently by an ophthalmologist after presenting with a 6month history of deteriorating vision. The patient had a 40 pack-year smoking history. Before his vision problem, he had never visited his general practitioner.
Investigations:
serum cortisol (09.00 h)389 nmol/L (200-700) serum testosterone8.6 nmol/L (9.0-35.0) plasma follicle-stimulating hormone2.1 U/L (1.0-7.0) plasma luteinising hormone2.4 U/L (1.0-10.0) serum prolactin896 mU/L (<360) serum thyroid-stimulating hormone1.4 mU/L (0.4-5.0)
MR scan of pituitarysee image

What is the most likely diagnosis?

A) Rathke's cyst
B) craniopharyngioma
C) prolactinoma
D) meningioma
E) non-functioning adenoma

5. 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) hydrocortisone
B) metformin
C) fludrocortisone
D) flutamide
E) cyproterone acetate

Solutions: