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MRCPUK SEND Exam Syllabus Topics:

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

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

2. A 23-year-old man presented with a history of discomfort with his gender for as long as he could remember. He believed he was transsexual.
What element of further history would most strongly support his self-diagnosis?

A) a long-standing intense wish to make his body conform to that of the preferred gender
B) the presence of gender somatic delusions that emerge and strengthen with time
C) seeking medical rationalisation for sexuality through genital surgery
D) sexual excitement by cross-dressing
E) conscious and absolute rejection of his sexual orientation as socially unacceptable

3. A 35-year-old man presented with newly diagnosed type 2 diabetes mellitus. He had no medical history of note.
When should he inform the UK Driver and Vehicle Licensing Agency (DVLA) of his medical condition?

A) if he requires laser treatment to one eye
B) if he becomes unable to read a car number plate with one eye at 20.5 m
C) if he starts taking an oral hypoglycaemic agent
D) if he starts using basal night-time insulin
E) immediately

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

5. An 80-year-old man was referred because of weight gain and low mood but said he was otherwise well. He had a complex cardiac history including a ventricular fibrillation arrest and a permanent pacemaker, but he had been very well for the past 3 years. He was taking amiodarone 100 mg daily, lisinopril 40 mg daily and furosemide 80 mg daily.
On examination, he had a pacemaker in situ and his pulse was 84 beats per minute and regular. He had a 2/6 mid-systolic murmur in the aortic area with no radiation, mild ankle oedema, and scanty basal crackles bilaterally on auscultation of his chest.
Investigations (before attending clinic):
serum thyroid-stimulating hormone19.0 mU/L (0.4-5.0)
serum free T411.0 pmol/L (10.0-22.0)
anti-thyroid peroxidase antibodies300 IU/mL (<50)
What is the most appropriate next step in management?

A) review with repeat thyroid tests in 3 months
B) start levothyroxine 25 micrograms daily
C) start levothyroxine 100 micrograms daily
D) start liothyronine sodium 10 micrograms twice daily
E) stop amiodarone

Solutions: