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MRCPUK SEND Exam Syllabus Topics:

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

1. 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) <130/80 mmHg
B) <125/70 mmHg
C) <150/90 mmHg
D) <140/80 mmHg
E) <120/70 mmHg

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

3. A 43-year-old man was in an ENT ward, having recently undergone removal of a carotid body tumour.
Five years previously, he had undergone a similar procedure in another hospital. He also recalled that his brother had undergone surgery for a similar condition, and that his father, who had since died, might also have had neck surgery.
The ENT surgeons were concerned that there might be an underlying genetic diagnosis.
What is the most likely diagnosis?

A) succinate dehydrogenase A deficiency
B) von Hippel-Lindau disease
C) neurofibromatosis type 1
D) multiple endocrine neoplasia type 2
E) succinate dehydrogenase D deficiency

4. A 26-year-old man was referred from the sexual health clinic, after small testes had been noted during treatment for genital warts. The patient reported recent loss of libido but there was no history of erectile dysfunction or delayed pubertal development. He was taking no regular medication. Approximately 3 years before presentation, he had taken anabolic steroids for 6 months to improve his muscle bulk.
On examination, normal facial, axillary and pubic hair was present. Testicular volume was 6 mL and his testes were firm.
Investigations:
serum testosterone4.0 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone21.0 U/L (1.0-7.0)
plasma luteinising hormone23.0 U/L (1.0-10.0)
serum prolactin420 mU/L (<360)
What is the most likely diagnosis?

A) Klinefelter's syndrome
B) exogenous anabolic steroid use
C) Kallmann's syndrome
D) haemochromatosis
E) microprolactinoma

5. A 25-year-old man presented with a 2-month history of thirst and polyuria. He had minimal weight loss and his body mass index was 26 kg/m2 (18-25). He had had sensorineural deafness since childhood. There was a very strong family history of sensorineural deafness and type 2 diabetes mellitus.
Urinalysis showed no ketones.
Investigations:
random plasma glucose18.0 mmol/L
What is the most appropriate next step in management?

A) water deprivation test to assess posterior pituitary function
B) measurement of glutamic acid decarboxylase antibodies
C) test for mitochondrial diabetes
D) test for HFE genotype
E) genetic testing for maturity-onset diabetes of the young

Solutions: