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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

A 77-year-old woman presented with a 10-week history of facial hirsutism, scalp hair loss and deepening of the voice.
On examination, her body mass index was 32 kg/m2 (18-25). Her blood pressure was 164/94 mmHg. She had coarse terminal hairs on her upper lip and beard areas. Abdominal examination was normal, but she refused examination of her external genitalia.
Investigations:
serum sodium144 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea7.7 mmol/L (2.5-7.0) serum creatinine122 umol/L (60-110) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum testosterone17.2 nmol/L (0.5-3.0) serum luteinising hormone2.2 U/L (>30.0)
What is the most appropriate initial investigation?

A. overnight dexamethasone suppression test (after 1 mg dexamethasone)
B. CT scan of abdomen and pelvis
C. plasma adrenocorticotropic hormone and serum cortisol
D. serum dehydroepiandrosterone sulphate
E. serum oestradiol

Question 2

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. Kallmann's syndrome
C. exogenous anabolic steroid use
D. haemochromatosis
E. microprolactinoma

Question 3

A 36-year-old woman was referred to the endocrine clinic with abnormal thyroid function
tests. She gave a 3-year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder.
Investigations:
serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4-5.0)
serum free T429.8 pmol/L (10.0-22.0)
serum free T33.5 pmol/L (3.0-7.0)
What is the most likely interpretation of her thyroid function test results?

A. resistance to thyroid hormone
B. assay interference
C. use of combined oral contraceptive pill
D. TSH-secreting pituitary adenoma
E. factitious thyrotoxicosis

Question 4

A 42-year-old woman, with type 1 diabetes mellitus of 22 years' duration, attended for annual review. She was using biphasic insulin twice daily and taking aspirin 75 mg, simvastatin 40 mg and ramipril 10 mg daily.
On examination, her blood pressure was 164/87 mmHg.
Investigations:
serum potassium5.9 mmol/L (3.5-4.9)
serum creatinine197 umol/L (60-110)
estimated glomerular filtration rate (MDRD)26 mL/min/1.73 m2 (>60)
haemoglobin A1c72 mmol/mol (20-42)
urinary albumin:creatinine ratio27.0 mg/mmol (<3.5)
urine culturenegative
What is the most important next step in management?

A. change to intensive insulin regimen
B. refer to a nephrologist
C. add furosemide
D. check bicarbonate
E. add aliskiren

Question 5

A 55-year-old man with mild polyuria and tiredness was seen on a renal ward. He had had a living-related kidney transplant 6 months previously. He had good graft function while being treated with prednisolone 5 mg daily, mycophenolate mofetil 1 g twice daily and tacrolimus 3 mg twice daily. He was also taking atenolol 50 mg daily and simvastatin 40 mg daily.
Investigations:
haemoglobin A1c75 mmol/mol (20-42)
random plasma glucose18.0 mmol/L
Which drug is most likely to be responsible for his diabetes of new onset?

A. simvastatin
B. prednisolone
C. tacrolimus
D. mycophenolate mofetil
E. atenolol

Solutions: