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MRCPUK SEND Exam Syllabus Topics:

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

1. A 26-year-old woman presented with recurrent Graves' disease. After discussing the treatment options, she chose radioiodine.
What dose of radioiodine is most appropriate in uncomplicated Graves' disease?

A) 1400-1600 MBq
B) 1000-1200 MBq
C) 400-600 MBq
D) 100-200 MBq
E) 700-900 MBq

2. 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) linagliptin
B) aspirin
C) aliskiren
D) losartan
E) simvastatin

3. A 54-year-old woman was referred for assessment of low bone mineral density. Three months previously, after complaining of bloating and flatulence, she had been found to have coeliac disease and had been started on a gluten-free diet. She had no history of fracture and had not lost height. There was no family history of osteoporosis. Her only medication was omeprazole.
Investigations:
serum corrected calcium2.42 mmol/L (2.20-2.60) serum alkaline phosphatase122 U/L (45-105)
plasma parathyroid hormone7.9 pmol/L (0.9-5.4)
DXA scansee image What is the most appropriate treatment?

A) alendronic acid, and calcium and vitamin D
B) alendronic acid alone
C) calcium and vitamin D, and intravenous zoledronic acid
D) calcium and vitamin D
E) strontium ranelate

4. An 18-year-old woman was referred by her general practitioner for further investigation of "funny turns" during which she developed palpitations, sweating, tremor, hunger, anxiety and paraesthesiae; all of these symptoms were relieved immediately by a sugary drink. She was otherwise well and was not taking any regular medication. There was a family history of type 1 diabetes mellitus. A spontaneous hypoglycaemic episode had not been captured and she was admitted to the diabetes/endocrine ward for a 72-hour fast. Her renal function was normal.
After a 12-hour fast she experienced her typical symptoms. Urinalysis showed no urinary ketones.
Investigations after 12-h fast:
fasting plasma glucose 2.0 mmol/L (3.0-6.0)
plasma insulin56 pmol/L (<21 after hypoglycaemia)
serum C-peptide514 pmol/L (180-360)
What is the most appropriate next step in management?

A) obtain a careful history looking for access to exogenous insulin
B) request a urinary sulphonylurea screen on sample obtained during the fast
C) MR scan of pancreas to localise an insulinoma
D) MR scan of abdomen and pelvis to localise a mesenchymal tumour producing insulin-like growth factor 2
E) coeliac axis angiography

5. A 44-year-old man was referred for investigation of cortisol excess. He had poorly controlled hypertension, and a long history of type 2 diabetes mellitus with retinopathy and peripheral neuropathy. His medication comprised aspirin, ramipril, atenolol, carbamazepine, metformin and simvastatin.
Initial investigations:
serum cortisol (09.00 h)350 nmol/L (200-700)
serum cortisol (22.00 h)48 nmol/L (50-250)
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol93 nmol/L (<50)
24-h urinary free cortisol (day 1)225 nmol (55-250)
24-h urinary free cortisol (day 2)200 nmol (55-250)
24-h urinary free cortisol (day 3)185 nmol (55-250)
What is the most appropriate next step in management?

A) dexamethasone-suppressed corticotrophin-releasing hormone test
B) MR scan of pituitary
C) reassure and discharge
D) high-dose 48-h dexamethasone suppression test
E) CT scan of adrenal glands

Solutions: