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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

A 33-year-old man was referred to the diabetes clinic with an 8-month history of weight loss and polydipsia. Two months previously his general practitioner had found a high fasting plasma glucose concentration of 17.5 mmol/L (3.0-6.0) and a haemoglobin A1c of 116 mmol/mol (20-42). The patient was taking metformin 1 g twice daily. He reported in the diabetes clinic that his home capillary blood glucose concentrations persisted to be high, ranging between 15-24 mmol/L.
On examination, his body mass index was 23 kg/m2 (18-25).
His blood tests were repeated in the diabetes clinic and he was treated with a basal bolus insulin regimen. Urinalysis was negative for ketones.
Investigations (in diabetes clinic):
haemoglobin A1c110 mmol/mol (20-42)
serum C-peptide200 pmol/L (180-360)
anti-glutamic acid decarboxylase (GAD)
antibodies69 IU/mL (<10)
anti-IA2 antibodiesnegative
What is the most likely diagnosis?

A. maturity-onset diabetes of the young
B. mitochondrial diabetes mellitus
C. haemochromatosis
D. latent autoimmune diabetes in adults
E. type 1 diabetes mellitus

Question 2

A 39-year-old man was admitted with severe burns.
On examination, he was noted to be persistently tachycardic.
Investigations:
serum thyroid-stimulating hormone0.2 mU/L (0.4-5.0)
serum free T410.0 pmol/L (10.0-22.0)
serum free T32.5 pmol/L (3.0-7.0)
What is the most appropriate next step in investigation of his thyroid status?

A. thyroid autoantibodies
B. radionuclide thyroid uptake scan
C. thyrotrophin-releasing hormone test
D. reverse tri-iodothyronine
E. repeat blood tests after recovery

Question 3

A 34-year-old woman with a 21-year history of type 1 diabetes mellitus had started treatment with subcutaneous insulin pump therapy 18 months previously. Her haemoglobin A1c before starting pump therapy was 77 mmol/mol (20-42) and she had experienced severe hypoglycaemic events without warning symptoms over the previous 4 years.
At review in clinic, she reported continuing episodes of severe hypoglycaemia without warning symptoms despite regular monitoring and advice from her insulin pump nurse specialist.
On examination, her blood pressure was 134/80 mmHg and fundoscopy revealed moderate background diabetic retinopathy. Examination of the feet revealed strong, palpable pedal pulses and early evidence of sensory neuropathy.
Investigations:
estimated glomerular filtration rate (MDRD)24 mL/min/1.73 m2 (>60)
haemoglobin A1c56 mmol/mol (20-42)
24-h urinary total protein2.3 g (<0.2)
What is the most appropriate next step in management?

A. refer for allogeneic pancreatic islet cell transplantation
B. refer for combined pancreas and kidney transplantation
C. refer for continuous glucose monitoring
D. refer for allogeneic pancreas transplantation
E. change to intensified subcutaneous insulin injections

Question 4

A 48-year-old man presented with gynaecomastia. His serum oestradiol was increased and a CT scan of adrenal glands revealed a 13-cm tumour of the left adrenal gland. Further workup showed increased secretion of 17-hydroxyprogesterone, cortisol and androstenedione. A diagnosis of adrenocortical carcinoma was suspected.
Investigations:
staging CT scan of chest and abdomenno evidence of metastasis
What is the most appropriate next step in management?

A. left adrenalectomy followed by adjuvant combination chemotherapy
B. MR scan of adrenal glands with chemical shift analysis
C. left adrenalectomy followed by adjuvant mitotane treatment
D. iodocholesterol scan
E. adrenal fine-needle biopsy

Question 5

A 46-year-old Afro-Caribbean man with sarcoidosis was found to have hypercalcaemia and was treated with prednisolone 20 mg/day. Within 3 weeks his serum calcium had fallen to within the reference range.
How do glucocorticoids reduce serum calcium in sarcoidosis?

A. increase intravascular fluid volume
B. reduces extrarenal 1-?-hydroxylase activity
C. direct calcium shift into cells
D. promote urinary calcium excretion
E. suppress parathyroid hormone secretion

Solutions: