MRCPUK SEND Exam Syllabus Topics:

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

Question #1
A 19-year-old man was seen in the diabetes clinic. He had lost 2 kg in weight since the diagnosis of diabetes mellitus 18 months previously. At presentation, his body mass index was 33 kg/m2 (18-25), his random plasma glucose was 18.0 mmol/L and his haemoglobin A1c was 56 mmol/mol (20-42). He was taking gliclazide, and metformin had been added later. His father and grandfather had developed diabetes mellitus during their twenties.
Investigations:
haemoglobin A1c56 mmol/mol (20-42)
serum C-peptide301 pmol/L (180-360)
anti-glutamic acid decarboxylase (GAD)
antibodiesnegative
What is the most likely diagnosis?

A. chronic pancreatitis
B. latent-onset diabetes of autoimmunity
C. maturity-onset diabetes of the young
D. type 1 diabetes mellitus
E. type 2 diabetes mellitus

Question #2
An 18-year-old man presented with delayed puberty.
On examination, he had a high arched palate. His sense of smell was intact, and he had a
family history of pubertal delay. Kallman's syndrome was suspected.
Investigations:
serum testosterone0.3 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.0 U/L (1.0-10.0)
bone age15 years
What further clinical finding would most strongly support the diagnosis of Kallman's
syndrome?

A. short stature
B. night blindness
C. bimanual synkinesia (mirror movements)
D. eunuchoid habitus
E. testes 6 mL bilaterally

Question #3
A 50-year-old woman with acromegaly presented with persistent sweating and headaches
despite having undergone trans-sphenoidal surgery and pituitary radiotherapy 2 years
previously. She had been intolerant of treatment with octreotide.
Investigations:
serum growth hormone11.1 ?g/L (<0.4)
serum insulin-like growth factor 186.2 nmol/L (5.6-23.3)
Following imaging, it was judged that there was no role for repeat surgery. She was treated
with pegvisomant 10 mg. Six months into treatment, her symptoms had improved.
Investigations (6 months later):
serum growth hormone20.3 ?g/L (<0.4)
serum insulin-like growth factor 115.2 nmol/L (5.6-23.3)
What is the most appropriate next step in management?

A. arrange another full course of pituitary radiotherapy
B. continue present dosage of pegvisomant
C. increase dosage of pegvisomant
D. stop pegvisomant
E. add cabergoline

Question #4
A 17-year-old girl with Turner's syndrome attended the clinic for review. She had been treated with growth hormone therapy for the previous 7 years, and had now reached her final adult height.
What is the most appropriate next step in management?

A. start to reduce growth hormone therapy with a view to discontinuing in 2 years' time
B. withdraw growth hormone therapy for 3 months and evaluate growth hormone secretion
C. continue growth hormone until 25 years old then reassess
D. stop growth hormone therapy
E. assess her bone density by DXA scan and continue growth hormone if bone mineral density is less than mean for age

Question #5
A 58-year-old man was referred to the endocrine clinic after a CT scan of abdomen had shown a 4.5-cm left adrenal mass, with a Hounsfield unit measurement of 11 (consistent with high lipid content). He had a 10-year history of type 2 diabetes mellitus and was taking metformin. He was also taking atenolol for hypertension.
On examination at the clinic, his blood pressure was 162/94 mmHg. He was centrally obese with a body mass index of 27 kg/m2 (18-25).
Investigations:
serum potassium3.9 mmol/L (3.5-4.9)
plasma renin activity (after 30 min upright)1.0 pmol/mL/h (3.0-4.3)
plasma aldosterone (after 4 h upright)680 pmol/L (330-830)
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol164 nmol/L (<50)
24-h urinary free cortisol132 nmol (55-250)
24-h urinary catecholamines
(adrenaline and noradrenaline)normal
As the lesion was >4 cm in diameter, laparoscopic adrenalectomy was recommended.
What is the most appropriate advice to give to the surgical team about perioperative
management?

A. give preoperative ?-adrenergic receptor blockade in case the lesion is an occult phaeochromocytoma
B. no special precautions are required
C. give corticosteroid cover during and after surgery and reassess postoperatively
D. measure cortisol and aldosterone 2 weeks postoperatively
E. short tetracosactide (Synacthen@) test 48 h postoperatively

Solutions: