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:

1. A 54-year-old man was referred from the urology department with erectile dysfunction.
On examination, he had normal secondary sexual characteristics. Testicular volume was
estimated at 15 mL bilaterally.
Investigations:
random plasma glucose8.0 mmol/L
serum testosterone8.1 nmol/L (9.0-35.0) plasma follicle-stimulating hormone3.4 U/L (1.0-7.0) plasma luteinising hormone4.7 U/L (1.0-10.0) serum prolactin410 mU/L (<360)
What is the most appropriate next step in management?

A) prescribe sildenafil
B) serum testosterone (09.00 h)
C) prescribe testosterone replacement
D) check for macroprolactinaemia
E) fasting plasma glucose

2. A 26-year-old woman was recovering from diabetic ketoacidosis and had been switched to her usual basal bolus insulin regimen. Her capillary blood glucose measurements during the day were high but fasting plasma glucose was in the range 5.0-7.0 mmol/L (3.0-6.0). She was drinking and eating normally.
On examination, her pulse was 76 beats per minute and her blood pressure was 106/66 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum bicarbonate22 mmol/L (20-28)
serum creatinine72 umol/L (60-110)
plasma glucose 2 h after breakfast21 mmol/L
What is the most appropriate next step in management?

A) change to twice daily pre-mixed insulin
B) increase bolus insulin with meal
C) start variable-rate intravenous insulin infusion
D) increase basal insulin at bed time
E) start glucose 5% with intravenous insulin

3. A 32-year-old woman with a recurrent history of Graves' thyrotoxicosis was being considered for radioiodine treatment. However, she wanted to conceive again at some stage and asked how soon she could become pregnant.
After what minimum interval would it be safe for her to conceive again?

A) 8 months
B) 6 months
C) 2 months
D) 12 months
E) 4 months

4. A 33-year-old woman presented with tiredness, palpitations, weight loss and emotional
lability 9 weeks after the birth of her third child.
On examination, she had a sinus tachycardia, a fine tremor, slight lid retraction and a mild
diffuse non-tender goitre.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T434.3 pmol/L (10.0-22.0)
technetium-99m scan of thyroid (20-min uptake)<1% (0.4-3.0)
What is the most appropriate treatment?

A) propranolol
B) propylthiouracil
C) potassium perchlorate
D) carbimazole
E) aqueous iodine oral solution

5. A 33-year-old woman was seen for diabetes review 2 months after her first pregnancy. Diabetes mellitus had been diagnosed at 18 weeks' gestation. She had experienced no symptoms; routine urinalysis had shown glucose 4+, with no ketones, and her fasting blood glucose concentration was 6.2 mmol/L (3.0-6.0), rising to 13.5 mmol/L (<7.8) in a 75-g oral glucose tolerance test. She had been treated with insulin during the pregnancy, and stopped after delivery. Her mother and maternal aunt had been treated for type 2 diabetes mellitus, and a maternal uncle for type 1 diabetes. Her body mass index was 23.7 kg/m2 (18-25).
Without insulin she remained well, with no osmotic symptoms, no weight loss and no ketosis.
Investigations:
fasting plasma glucose8.4 mmol/L (3.0-6.0)
haemoglobin A1c68 mmol/mol (20-42)
oral glucose tolerance test (75 g):
fasting plasma glucose7.9 mmol/L (3.0-6.0)
2-h plasma glucose13.8 mmol/L (<7.8)
serum insulin72 pmol/L (<186)
serum C-peptide945 pmol/L (180-360)
A trial of therapy with gliclazide 40 mg once daily led to a significant improvement in her blood glucose.
What is the most likely cause of her diabetes?

A) maturity-onset diabetes of the young caused by HNF-1? mutation
B) type 2 diabetes mellitus
C) maturity-onset diabetes of the young caused by glucokinase mutation
D) type 1 diabetes mellitus
E) latent autoimmune diabetes in adulthood

Solutions: