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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

An 18-year-old woman was referred by her general practitioner for further investigation of "funny turns" during which she developed palpitations, sweating, tremor, hunger, anxiety and paraesthesiae; all of these symptoms were relieved immediately by a sugary drink. She was otherwise well and was not taking any regular medication. There was a family history of type 1 diabetes mellitus. A spontaneous hypoglycaemic episode had not been captured and she was admitted to the diabetes/endocrine ward for a 72-hour fast. Her renal function was normal.
After a 12-hour fast she experienced her typical symptoms. Urinalysis showed no urinary ketones.
Investigations after 12-h fast:
fasting plasma glucose 2.0 mmol/L (3.0-6.0)
plasma insulin56 pmol/L (<21 after hypoglycaemia)
serum C-peptide514 pmol/L (180-360)
What is the most appropriate next step in management?

A. coeliac axis angiography
B. MR scan of abdomen and pelvis to localise a mesenchymal tumour producing insulin-like growth factor 2
C. obtain a careful history looking for access to exogenous insulin
D. request a urinary sulphonylurea screen on sample obtained during the fast
E. MR scan of pancreas to localise an insulinoma

Question 2

A 27-year-old woman presented with oligomenorrhoea and hirsutism, and a 2-year history of infertility. Her body mass index was 26 kg/m2 (18-25). Her partner had a recent normal sperm count and motility test.
Investigations:
serum androstenedione17.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone2 nmol/L (1-10)
serum testosterone2.8 nmol/L (0.5-3.0)
serum sex hormone binding globulin18 nmol/L (40-137)
serum follicle-stimulating hormone2.3 U/L (2.5-10.0)
serum luteinising hormone8.3 U/L (2.5-10.0)
serum prolactin152 mU/L (<360)
A diagnosis of polycystic ovary syndrome was made.
What is the most effective next step to help her conceive?

A. in vitro fertilisation
B. orlistat
C. metformin
D. diet and exercise
E. clomifene

Question 3

A 32-year-old woman presented at 34 weeks of pregnancy, after an episode of vaginal bleeding. Gestational diabetes had been diagnosed at 28 weeks and insulin was started at 29 weeks. Her pre-pregnancy body mass index was 32 kg/m2 (18-25) and there was no family history of diabetes. She was treated with betamethasone 12 mg over 2 days. She was taking 60 units of insulin subcutaneously daily (40 units prandial in three divided doses, and 20 units intermediate-acting insulin), which had been unchanged for 3 weeks.
On examination, she was apyrexial, her pulse was 96 beats per minute and her blood pressure was 124/74 mmHg. Urinalysis showed blood 1+, protein 1+, glucose 2+, ketones 3+.
Investigations:
serum sodium134 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107) serum urea5.0 mmol/L (2.5-7.0) serum creatinine90 umol/L (60-110) random plasma glucose7.2 mmol/L
What is the most appropriate next step in management?

A. start intravenous insulin
B. increase subcutaneous insulin doses by 2-4 units
C. continue to monitor blood glucose in hospital
D. measure venous bicarbonate
E. discharge and monitor blood glucose at home

Question 4

A 73-year-old man with type 2 diabetes mellitus was reviewed because of borderline hypertension. He was taking metformin 1 g twice daily, gliclazide 160 mg twice daily, aspirin 75 mg daily and simvastatin 20 mg at night. He had a history of diabetic retinopathy.
On examination, his body mass index was 34 kg/m2 (18-25); his blood pressure was 146/86 mmHg. When he returned 2 months later, his blood pressure was 142/88 mmHg.
Investigations:
serum creatinine102 umol/L (60-110)
haemoglobin A1c66 mmol/mol (20-42)
urinary albumin:creatinine ratio
(untimed specimen)7.4 mg/mmol (<2.5)
According to NICE guidelines (CG66, May 2008), what is the target for blood pressure reduction?

A. <140/80 mmHg
B. <120/70 mmHg
C. <130/80 mmHg
D. <150/90 mmHg
E. <125/70 mmHg

Question 5

A 16-year-old boy was referred to the endocrine clinic with symptoms of delayed puberty.
On examination, he had a reduced sense of smell, small-sized testes and underdeveloped
secondary sexual characteristics.
Investigations:
serum testosterone3.5 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.5 U/L (1.0-10.0)
serum prolactin220 mU/L (<360)
MR scan of brainnormal
He asked about his future fertility.
What will be the most useful agent for him to achieve fertility?

A. testosterone
B. bromocriptine
C. gonadotropin-releasing hormones
D. octreotide
E. clomifene

Solutions: