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MRCPUK SEND Exam Syllabus Topics:

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

1. A 17-year-old boy with a 7-year history of type 1 diabetes mellitus was transferred to the adolescent diabetes clinic. He had a history of poor clinic attendance. He admitted to having lost weight recently. His eyes had been photographed by a community ophthalmologist 1 week previously. A photograph of the right fundus is shown (see image).

Investigations:
haemoglobin A1c104 mmol/mol (20-42)
What is the most likely explanation for the retinal appearance?

A) retinitis pigmentosa
B) drusen
C) macular oedema
D) preproliferative diabetic retinopathy
E) benign choroidal naevus

2. A 44-year-old man was referred for investigation of cortisol excess. He had poorly controlled hypertension, and a long history of type 2 diabetes mellitus with retinopathy and peripheral neuropathy. His medication comprised aspirin, ramipril, atenolol, carbamazepine, metformin and simvastatin.
Initial investigations:
serum cortisol (09.00 h)350 nmol/L (200-700)
serum cortisol (22.00 h)48 nmol/L (50-250)
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol93 nmol/L (<50)
24-h urinary free cortisol (day 1)225 nmol (55-250)
24-h urinary free cortisol (day 2)200 nmol (55-250)
24-h urinary free cortisol (day 3)185 nmol (55-250)
What is the most appropriate next step in management?

A) CT scan of adrenal glands
B) dexamethasone-suppressed corticotrophin-releasing hormone test
C) MR scan of pituitary
D) reassure and discharge
E) high-dose 48-h dexamethasone suppression test

3. A 17-year-old girl was referred to the transition clinic. She was taking hydrocortisone 10 mg twice daily and fludrocortisone 150 micrograms daily following a failed short tetracosactide (Synacthen@) test 5years previously. She had entered puberty at the age of 10 but had never achieved adult breast development or menarche.
Investigations:
haemoglobin95 g/L (115-165)
MCV124 fL (80-96)
white cell count8.4 ? 109/L (4.0-11.0)
platelet count334 ? 109/L (150-400)
serum sodium138 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum urea3.5 mmol/L (2.5-7.0)
serum corrected calcium1.80 mmol/L (2.20-2.60)
serum follicle-stimulating hormone67.9 U/L (2.5-10.0)
serum luteinising hormone56.4 U/L (2.5-10.0)
What is the most likely diagnosis?

A) autoimmune polyglandular syndrome type 1
B) hypothalamic germinoma
C) Turner's syndrome
D) pituitary stalk interruption syndrome
E) atypical congenital adrenal hyperplasia

4. An 85-year-old woman was referred with a lump in her neck. She had no symptoms of thyroid disease.
On examination, she had a 2 ? 3-cm firm mass at the lower pole in the right thyroid lobe. Her resting pulse was 90 beats per minute and regular.
Investigations:
serum thyroid-stimulating hormone3.5 mU/L (0.4-5.0)
serum free T415.0 pmol/L (10.0-22.0)
serum free T36.2 pmol/L (3.0-7.0)
anti-thyroid peroxidase antibodies28 IU/mL (<50) ultrasound scan of thyroidmixed cystic/solid mass with scattered microcalcifications
fine-needle aspiration biopsyThy 3a
What is the most appropriate next step in her management?

A) subtotal thyroidectomy
B) CT scan of neck
C) repeat fine-needle aspiration
D) ablative radioiodine treatment
E) PET scan of thyroid

5. A 37-year-old woman presented with a 2-year history of increasingly frequent flushing episodes. She described alternating loose bowel motions and constipation. She had also noted menstrual irregularity. She had no respiratory symptoms. She denied headache or chest pain, but complained of palpitations.
On examination, she appeared well. Her blood pressure was 128/82 mmHg.
Investigations:
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next investigation?

A) fasting plasma gut hormones
B) serum gonadotrophins
C) urinary metanephrines
D) urinary 5-hydroxyindoleacetic acid
E) plasma metanephrines

Solutions: