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MRCPUK SEND Exam Syllabus Topics:

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

1. A 17-year-old Caucasian girl presented with primary amenorrhea.
On examination, her body mass index was 21 kg/m2 (18-25). Her body habitus was normal and she had appropriate breast development. There was no hirsutism or acne.
Investigations:
serum oestradiol<180 pmol/L (200-400) serum testosterone31.7 nmol/L (0.5-3.0) serum follicle-stimulating hormone4.0 U/L (2.5-10.0) serum luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?

A) complete androgen insensitivity syndrome
B) ovarian hyperthecosis
C) adrenocortical carcinoma
D) androgen-secreting ovarian tumour
E) polycystic ovary syndrome

2. A 28-year-old woman was referred with an 8-year history of progressive weight gain, hypertension and abdominal striae. She had no family history of note and was not taking any medication.
On examination, her blood pressure was 158/86 mmHg. There was central obesity with abdominal striae. There was mild proximal myopathy of the lower limbs.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium3.4 mmol/L (3.5-4.9)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol180 nmol/L (<50)
An MR scan of pituitary showed an invasive adenoma extending laterally into the cavernous sinuses bilaterally. Superiorly, the adenoma was in contact with, but not distorting, the optic chiasm. Formal visual field examination was normal.
What is the most appropriate next step in management?

A) trans-sphenoidal hypophysectomy
B) pituitary radiotherapy
C) adrenolytic therapy
D) somatostatin agonist therapy
E) bilateral adrenalectomy

3. A 59-year-old man with an 8-year history of type 2 diabetes mellitus was seen in the outpatient clinic. He had worsening renal function in the absence of microalbuminuria.
On examination, his blood pressure was 175/90 mmHg. He had a femoral bruit, and absent dorsalis pedis pulses bilaterally.
Investigations:
serum creatinine150 umol/L (60-110)
estimated glomerular filtration rate (MDRD)39 mL/min/1.73m2 (>60)
In addition to addressing his blood pressure, what is the most appropriate next investigation?

A) MR angiography of renal arteries
B) mercaptoacetyltriglycine (MAG3) renography
C) captopril diethylene triamine pentacaetic acid (DTPA) scan
D) lower limb angiography
E) renal ultrasound scan with Doppler studies

4. A 34-year-old man was referred to the diabetes outpatient clinic with impaired glucose tolerance. He had a family history of diabetes mellitus and had a body mass index of 34.6 kg/m2 (18-25).
On examination, his blood pressure was 140/82 mmHg.
He wished to delay the onset of frank diabetes mellitus.
What is the most effective way of achieving this outcome?

A) acarbose
B) metformin
C) orlistat
D) ramipril
E) lifestyle changes aimed at weight loss

5. A 47-year-old nuclear physics professor was referred for advice before taking up an overseas position, overseeing the dismantling of a reactor at the site of a recent nuclear accident. She stated that she would face a small risk of being exposed to significant radioactive contamination during her work and was concerned about her future risk of thyroid cancer.
What is the most appropriate advice?

A) avoid consuming local milk and vegetables
B) take selenium tablets
C) no precautions are necessary for people aged 40 years or over
D) wear lead neck shield while outdoors
E) take potassium iodide tablets

Solutions: