MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) : SEND

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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

A 36-year-old woman was seen in the clinic with a recurrence of hyperthyroidism after a 2year remission. She had been treated with carbimazole for 18 months following her original presentation. She was moderately symptomatic and was keen to be treated in the same way again. She was planning a pregnancy.
Investigations: serum prolactin240 mU/L (<360) serum thyroid-stimulating hormone<0.1 mU/L (0.4-5.0) serum free T428.0 pmol/L (10.0-22.0)
anti-thyroid-stimulating hormone receptor antibodies44 U/L (<7)
What is the most appropriate next step in management?

A. block-and-replace treatment with carbimazole and levothyroxine
B. referral for thyroidectomy
C. carbimazole
D. propylthiouracil
E. radioiodine treatment

Question 2

An 18-year-old woman was found to have a blood pressure of 164/102 mmHg at a preemployment medical examination. She gave no family history of hypertension. On enquiry, she said that she had not yet started to menstruate.
On initial clinical examination, she appeared well. She was 1.72 m tall (>90th centile) and had a body mass index of 22 kg/m2 (18-25). There was no evidence of axillary hair, and pubic hair was scanty (Tanner stage 1). Breast development was immature (Tanner stage 1).
Investigations:
serum sodium142 mmol/L (137-144)
serum potassium2.7 mmol/L (3.5-4.9)
serum urea4.6 mmol/L (2.5-7.0)
serum creatinine102 umol/L (60-110)
estimated glomerular filtration rate (MDRD)>60 mL/min/1.73 m2 (>60)
plasma renin activity (after 30 min supine)1.0 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)125 pmol/L (135-400)
serum cortisol (09.00 h)190 nmol/L (200-700)
What is the most likely underlying diagnosis?

A. adrenal 17-hydroxylase deficiency
B. 11-hydroxysteroid dehydrogenase type 2 deficiency
C. deoxycorticosterone-secreting adrenal tumour
D. adrenal 11-hydroxylase deficiency
E. adrenal 21-hydroxylase deficiency

Question 3

A 34-year-old woman with Addison's disease reported four adrenal crises over the preceding 6 months, requiring hospital admission and intravenous administration of hydrocortisone. At outpatient follow-up, she was taking hydrocortisone 15 mg in the morning and 10 mg at midday, and fludrocortisone 50 micrograms daily.
What is the most important next step in management to prevent further crises?

A. change to sustained-release hydrocortisone
B. increase dosage of hydrocortisone
C. measure plasma adrenocorticotropic hormone
D. measure post-dose 09.00 h cortisol
E. measure plasma renin

Question 4

A 24-year-old woman was referred with an 18-month history of worsening hirsutism, primarily on her face, but also new hair growth on her chest. She was shaving weekly. She had always been overweight, but had recently gained 5 kg and her body mass index was 31 kg/m2 (18-25). Her periods were regular.
What is the most relevant next investigation?

A. serum testosterone
B. serum 17-hydroxyprogesterone
C. overnight dexamethasone suppression test (after 1 mg dexamethasone)
D. plasma thyroid-stimulating hormone
E. serum dehydroepiandrosterone

Question 5

A 72-year-old man with a dense residual hemiparesis and unsafe swallow was fed via a percutaneous gastrostomy for 20 hours each day. He resided in a nursing home and had type 2 diabetes mellitus that had been well controlled on metformin.
His glucose concentrations were uncontrolled on metformin powder at maximum dose. While not being fed, his blood glucose was measured.
Investigations:
capillary blood glucose3.1 mmol/L
According to the Joint British Diabetes Societies Guidelines (2012), what is the most appropriate management?

A. restart feed to deliver carbohydrate 20 g rapidly
B. Fortisip@ 110 mL
C. Glucogel@ ? 2 given buccally
D. Glucogel@ ? 2 down gastrostomy tube
E. glucose 20% 150 mL intravenously

Solutions: