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MRCPUK SEND Exam Syllabus Topics:

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

1. A 28-year-old woman presented to the emergency department with a 3-day history of abdominal pain. Her past medical history included intermenstrual bleeding, and she was undergoing 6-monthly renal ultrasound surveillance for a cystic lesion.
Investigations:
serum creatinine84 umol/L (60-110)
serum corrected calcium3.20 mmol/L (2.20-2.60)
serum phosphate0.7 mmol/L (0.8-1.4)
plasma parathyroid hormone19.5 pmol/L (0.9-5.4)
What is the most likely condition underlying the clinical presentation?

A) Cowden's syndrome
B) hyperparathyroidism-jaw tumour syndrome
C) multiple endocrine neoplasia type 1
D) multiple endocrine neoplasia type 2B
E) von Hippel-Lindau syndrome

2. A 52-year-old woman was referred to the clinic having lost 3-4 kg in weight over the previous 3 months. She also had palpitations and a sense of tremulousness. A diagnosis of thyrotoxicosis was confirmed by a blood test arranged by her general practitioner (GP).
Investigations (arranged by GP):
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T435.8 pmol/L (10.0-22.0)
serum free T310.0 pmol/L (3.0-7.0)
On examination at her first clinic visit, she had a fine tremor, her pulse was 92 beats per minute and regular, and her eyes appeared normal. Her right thyroid lobe was moderately enlarged, and her left lobe was normal on examination. There was no associated lymphadenopathy. A technetium-99m thyroid isotope uptake scan was arranged (see image).

What is the most likely cause of her thyrotoxicosis?

A) toxic multinodular goitre
B) Graves' disease
C) toxic thyroid adenoma
D) factitious thyrotoxicosis
E) de Quervain's thyroiditis

3. A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty.
Clinical examination showed central obesity, a body mass index of 32 kg/m2 (18-25) and a blood pressure of 140/90 mmHg.
The following results were obtained within 1 week of her last menstrual period.
Investigations:
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol30 nmol/L (<50)
serum dehydroepiandrosterone sulphate12 umol/L (3-12)
serum androstenedione10.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone38 nmol/L (1-10)
serum oestradiol200 pmol/L (200-400)
serum testosterone3.5 nmol/L (0.5-3.0)
serum sex hormone binding globulin30 nmol/L (40-137)
plasma follicle-stimulating hormone4.0 U/L (2.5-10.0)
plasma luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?

A) Cushing's syndrome
B) adrenal androgen-secreting tumour
C) polycystic ovary syndrome
D) ovarian androgen-secreting tumour
E) late-onset congenital adrenal hyperplasia

4. A 32-year-old woman presented at 34 weeks of pregnancy, after an episode of vaginal bleeding. Gestational diabetes had been diagnosed at 28 weeks and insulin was started at 29 weeks. Her pre-pregnancy body mass index was 32 kg/m2 (18-25) and there was no family history of diabetes. She was treated with betamethasone 12 mg over 2 days. She was taking 60 units of insulin subcutaneously daily (40 units prandial in three divided doses, and 20 units intermediate-acting insulin), which had been unchanged for 3 weeks.
On examination, she was apyrexial, her pulse was 96 beats per minute and her blood pressure was 124/74 mmHg. Urinalysis showed blood 1+, protein 1+, glucose 2+, ketones 3+.
Investigations:
serum sodium134 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107) serum urea5.0 mmol/L (2.5-7.0) serum creatinine90 umol/L (60-110) random plasma glucose7.2 mmol/L
What is the most appropriate next step in management?

A) start intravenous insulin
B) continue to monitor blood glucose in hospital
C) discharge and monitor blood glucose at home
D) measure venous bicarbonate
E) increase subcutaneous insulin doses by 2-4 units

5. A 48-year-old man was investigated for a 6-month history of tiredness. There was no other medical history and he was taking no medication.
Investigations:
estimated glomerular filtration rate (MDRD)36 mL/min/1.73 m2 (>60) serum corrected calcium2.25 mmol/L (2.20-2.60) serum phosphate1.1 mmol/L (0.8-1.4)
plasma parathyroid hormone8.1 pmol/L (0.9-5.4) serum 25-OH-cholecalciferol48 nmol/L (45-90)
What is the most important next step in management?

A) refer for nephrological advice
B) prescribe calcium and vitamin D supplements
C) reassure and repeat in 3 months
D) reassure and discharge from clinic
E) refer for parathyroidectomy

Solutions: