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MRCPUK SEND Exam Syllabus Topics:

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

1. A 56-year-old woman was referred for assessment of asymptomatic hypercalcaemia.
Investigations:
serum corrected calcium2.73 mmol/L (2.20-2.60)
plasma parathyroid hormone8.9 pmol/L (0.9-5.4)
urinary calcium:creatinine clearance ratio0.002
An X-ray of abdomen was normal and imaging of her neck showed no evidence of a
parathyroid adenoma.
What is the pattern of inheritance of this condition?

A) autosomal dominant
B) autosomal recessive
C) X-linked recessive
D) X-linked dominant
E) mitochondrial

2. An 18-year-old man, whose ambition was to become a member of the elite armed forces, presented with gynaecomastia. His weekly alcohol consumption was 35 units.
On examination, he had normal secondary sexual characteristics, a well-developed, muscular physique and modest, slightly tender bilateral gynaecomastia. Testes were 10 mL with soft texture.
Investigations:
haemoglobin160 g/L (130-180)
MCV96 fL (80-96)
serum dehydroepiandrosterone sulphate4 umol/L (2-10)
serum oestradiol180 pmol/L (<180)
serum testosterone (09.00 h)6.0 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone1.0 U/L (1.0-7.0)
plasma luteinising hormone0.7 U/L (1.0-10.0)
serum prolactin420 mU/L (<360)
What is the most likely diagnosis?

A) oestrogen-secreting testicular tumour
B) alcohol excess
C) androgen abuse
D) primary hypogonadotrophic hypogonadism
E) persistence of pubertal gynaecomastia

3. A 17-year-old boy, with short stature, obesity and neurobehavioural problems, was referred because of cold intolerance.
On examination, he and his mother had similar body habitus and short fingers (brachydactyly).
Investigations (before attending clinic):
serum sodium143 mmol/L (137-144) serum potassium4.4 mmol/L (3.5-4.9) serum creatinine93 umol/L (60-110) serum corrected calcium2.02 mmol/L (2.20-2.60) serum phosphate1.7 mmol/L (0.8-1.4)
serum thyroid-stimulating hormone16.0 mU/L (0.4-5.0) serum free T410.0 pmol/L (10.0-22.0) plasma parathyroid hormone27.0 pmol/L (0.9-5.4)
His mother's blood tests were all normal.
What is the most likely diagnosis in this boy?

A) pseudohypoparathyroidism
B) McCune-Albright syndrome
C) DiGeorge syndrome
D) polyglandular autoimmune syndrome type 1
E) pseudopseudohypoparathyroidism

4. A 25-year-old woman with type 1 diabetes mellitus presented with light-headedness, nausea, thirst and vomiting of 3 days' duration. She was fully conscious.
On examination, her pulse was 104 beats per minute and her blood pressure was 104/64 mmHg. Urinalysis showed glucose 2+, ketones 3+.
Investigations:
serum sodium150 mmol/L (137-144)
serum potassium5.5 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107)
serum urea5.0 mmol/L (2.5-7.0)
serum creatinine90 umol/L (60-110)
random plasma glucose20.0 mmol/L
arterial blood gases, breathing air:
PO212.4 kPa (11.3-12.6)
PCO23.4 kPa (4.7-6.0)
pH7.15 (7.35-7.45)
H+70 nmol/L (35-45)
bicarbonate6 mmol/L (21-29)
What intravenous fluid should be given over the first 30 minutes?

A) sodium chloride 0.9%
B) sodium chloride 0.18% and glucose 4%
C) colloid solution
D) sodium chloride 0.45%
E) compound sodium lactate

5. A 58-year-old man presented with tiredness and breathlessness. He had been treated for type 2 diabetes mellitus and hypertension for the past 10 years. He was free of complications. His current medication included ramipril 10 mg daily, rosuvastatin 10 mg daily, metformin 500 mg three times daily, dapagliflozin 10 mg once daily and exenatide 10 micrograms twice daily.
On examination, his body mass index was 36 kg/m2 (18-25).
Investigations:
haemoglobin93 g/L (130-180)
MCV110 fL (80-96)
white cell count3.6 ? 109/L (4.0-11.0)
platelet count140 ? 109/L (150-400)
reticulocyte count0.5% (0.5-2.4)
serum ferritin250 ug/L (15-300)
serum vitamin B1240 ng/L (160-760)
serum folate3.0 ug/L (2.0-11.0)
Which medication is most likely to be contributing to his anaemia?

A) dapagliflozin
B) rosuvastatin
C) exenatide
D) ramipril
E) metformin

Solutions: