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MRCPUK SEND Exam Syllabus Topics:

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

1. A 45-year-old woman was found to be hypertensive by her general practitioner. She was otherwise well and was not taking any medication. However, she regularly ate health food containing liquorice. There was no family history of significant illness.
On examination, her blood pressure was 170/110 mmHg.
Investigations:
serum sodium140 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine70 umol/L (60-110)
plasma renin activity (after 30 min supine)0.5 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)450 pmol/L (135-400)
During the investigations, her blood pressure was controlled with doxazosin. What is the most likely diagnosis?

A) renal artery stenosis
B) Gitelman's syndrome
C) pseudohyperaldosteronism
D) apparent mineralocorticoid excess
E) primary hyperaldosteronism

2. A 64-year-old man was referred to the foot clinic. He had tripped over his cat 1 week previously and had complained of an ache in his left foot since then. He had a 12-year history of type 2 diabetes mellitus and hypertension. He was taking metformin, gliclazide, pioglitazone, bendroflumethiazide, ramipril, simvastatin and aspirin.
On examination, his blood pressure was 154/88 mmHg. Foot examination showed absent vibration perception to his ankle. The dorsalis pedis and posterior tibial pulses were easily palpable on both feet.
Investigations:
serum urea12.6 mmol/L (2.5-7.0) serum creatinine166 umol/L (60-110) haemoglobin A1c79 mmol/mol (20-42)
urinary albumin:creatinine ratio8.7 mg/mmol (<2.5)
X-ray of left footsee image

What is the most appropriate initial management for this deformity?

A) referral for urgent surgery
B) custom-made hospital footwear
C) full contact plaster cast
D) removable aircast boot
E) bed rest

3. A 73-year-old man with type 2 diabetes mellitus was referred to the outpatient clinic. He had a history of microalbuminuria and hypertension. He was taking ramipril, amlodipine and metformin.
On examination, his blood pressure was 125/75 mmHg.
Investigations:
haemoglobin A1c57 mmol/mol (20-42)
What additional drug is most likely to prevent glomerular filtration rate decline?

A) simvastatin
B) losartan
C) aspirin
D) aliskiren
E) linagliptin

4. A 17-year-old girl was referred to the transition clinic. She was taking hydrocortisone 10 mg twice daily and fludrocortisone 150 micrograms daily following a failed short tetracosactide (Synacthen@) test 5years previously. She had entered puberty at the age of 10 but had never achieved adult breast development or menarche.
Investigations:
haemoglobin95 g/L (115-165)
MCV124 fL (80-96)
white cell count8.4 ? 109/L (4.0-11.0)
platelet count334 ? 109/L (150-400)
serum sodium138 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum urea3.5 mmol/L (2.5-7.0)
serum corrected calcium1.80 mmol/L (2.20-2.60)
serum follicle-stimulating hormone67.9 U/L (2.5-10.0)
serum luteinising hormone56.4 U/L (2.5-10.0)
What is the most likely diagnosis?

A) pituitary stalk interruption syndrome
B) Turner's syndrome
C) autoimmune polyglandular syndrome type 1
D) atypical congenital adrenal hyperplasia
E) hypothalamic germinoma

5. A 36-year-old man of African origin attended the clinic 2 weeks after discharge from hospital following his first admission with diabetic ketoacidosis. He had made a rapid recovery and had been discharged taking subcutaneous insulin twice daily.
At clinic, he reported home blood glucose measurements of 4-6mmol/L, occasional symptomatichypoglycaemia and a total daily insulin dose of 12 units. He asked if his glucose-lowering treatment should change.
Which test is most likely to predict prolonged insulin independence?

A) fasting C-peptide concentration
B) glucagon-stimulated C-peptide concentration
C) anti-islet cell antibodies
D) genotyping for monogenic diabetes
E) anti-glutamic acid decarboxylase antibodies

Solutions: