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MRCPUK SEND Exam Syllabus Topics:

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

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

2. A 17-year-old boy, with short stature, obesity and neurobehavioural problems, was referred because of cold intolerance.
On examination, he and his mother had similar body habitus and short fingers (brachydactyly).
Investigations (before attending clinic):
serum sodium143 mmol/L (137-144) serum potassium4.4 mmol/L (3.5-4.9) serum creatinine93 umol/L (60-110) serum corrected calcium2.02 mmol/L (2.20-2.60) serum phosphate1.7 mmol/L (0.8-1.4)
serum thyroid-stimulating hormone16.0 mU/L (0.4-5.0) serum free T410.0 pmol/L (10.0-22.0) plasma parathyroid hormone27.0 pmol/L (0.9-5.4)
His mother's blood tests were all normal.
What is the most likely diagnosis in this boy?

A) McCune-Albright syndrome
B) pseudohypoparathyroidism
C) polyglandular autoimmune syndrome type 1
D) pseudopseudohypoparathyroidism
E) DiGeorge syndrome

3. A 35-year-old woman was referred with a left lower thyroid lesion. She was asymptomatic.
Examination confirmed the presence of a 2 ? 3-cm, firm, mobile, non-tender mass.
Investigations:
ultrasound-guided fine-needle aspiration biopsyThy 5
How is Thy 5 defined?

A) follicular lesions
B) non-diagnostic or inadequate
C) abnormal, suspicious (but not diagnostic of) malignancy
D) non-neoplastic (consistent with nodular goitre or thyroiditis)
E) abnormal, diagnostic of malignancy

4. A 17-year-old boy was concerned about his height. He had been treated for Crohn's disease since the age of 13 with a combination of topical and systemic corticosteroids and azathioprine. He was currently taking mercaptopurinE.
On examination, his height was on the 25th centile.
Investigations:
X-ray of right kneesee image

What is the most appropriate next step in management?

A) treat with growth hormone
B) advise him that he will continue to grow for 12 months
C) refer for leg lengthening surgery
D) advise him that growth is complete
E) investigate for growth hormone deficiency

5. A 63-year-old woman with diet-controlled type 2 diabetes mellitus was admitted with biventricular cardiac failure. She had a history of myocardial infarction 3 years previously. She was taking aspirin 75 mg daily, simvastatin 20 mg daily, furosemide 40 mg daily and ramipril 10 mg daily. She responded well to increased diuretic therapy.
Urinalysis showed glucose 1+.
Investigations:
haemoglobin112 g/L (115-165)
serum sodium135 mmol/L (137-144)
serum potassium4.7 mmol/L (3.5-4.9)
serum creatinine162 umol/L (60-110)
estimated glomerular filtration rate28 mL/min/1.73 m2 (>60)
serum troponin T<0.01 ug/L (<0.01)
haemoglobin A1c66 mmol/mol (20-42)
What is the most appropriate treatment for her diabetes after discharge?

A) gliclazide
B) linagliptin
C) dapagliflozin
D) subcutaneous insulin
E) exenatide

Solutions: