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MRCPUK SEND Exam Syllabus Topics:

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

1. An 18-year-old man presented to the thyroid clinic complaining of a lump in his neck that had been present for 9 weeks. It was not painful. At the age of 12, he had developed acute lymphoblastic leukaemia and had undergone a bone marrow transplant preceded by total body irradiation and cyclophosphamide.
On examination, he was euthyroid. There was a 1.5-cm firm mass on the left side of the neck, which moved when he swallowed.
Investigations:
serum thyroid-stimulating hormone1.9 mU/L (0.4-5.0)
serum free T416.8 pmol/L (10.0-22.0)
What is the most appropriate initial course of action?

A) ultrasound-guided fine-needle aspiration of the nodule
B) CT scan of neck and thorax
C) technetium-99m scintigraphy scan of thyroid
D) surgical referral for hemithyroidectomy
E) FDG-PET-CT scan

2. A 34-year-old woman with a 21-year history of type 1 diabetes mellitus had started treatment with subcutaneous insulin pump therapy 18 months previously. Her haemoglobin A1c before starting pump therapy was 77 mmol/mol (20-42) and she had experienced severe hypoglycaemic events without warning symptoms over the previous 4 years.
At review in clinic, she reported continuing episodes of severe hypoglycaemia without warning symptoms despite regular monitoring and advice from her insulin pump nurse specialist.
On examination, her blood pressure was 134/80 mmHg and fundoscopy revealed moderate background diabetic retinopathy. Examination of the feet revealed strong, palpable pedal pulses and early evidence of sensory neuropathy.
Investigations:
estimated glomerular filtration rate (MDRD)24 mL/min/1.73 m2 (>60)
haemoglobin A1c56 mmol/mol (20-42)
24-h urinary total protein2.3 g (<0.2)
What is the most appropriate next step in management?

A) refer for combined pancreas and kidney transplantation
B) change to intensified subcutaneous insulin injections
C) refer for allogeneic pancreas transplantation
D) refer for allogeneic pancreatic islet cell transplantation
E) refer for continuous glucose monitoring

3. A 26-year-old physiologist was seen in the diabetes outpatient clinic. She had type 1 diabetes mellitus of 9 months' duration, treated with subcutaneous insulin.
She asked what symptoms of hypoglycaemia she might experience.
In what order are responses to hypoglycaemia most likely to occur as blood glucose falls?

A) counter-regulatory hormones, neuroglycopenia, autonomic
B) autonomic, neuroglycopenia, counter-regulatory hormones
C) counter-regulatory hormones, autonomic, neuroglycopenia
D) autonomic, counter-regulatory hormones, neuroglycopenia
E) neuroglycopenia, autonomic, counter-regulatory hormones

4. A 55-year-old male-to-female transsexual was reviewed in clinic. She lived as a woman but had not undergone gender reassignment surgery. She was treated with cyproterone acetate 50 mg twice daily and estradiol 2 mg twice daily.
What are the most important tests for monitoring safe replacement?

A) lipid profile and serum prostate-specific antigen
B) serum prostate-specific antigen and full blood count
C) liver function tests and serum prostate-specific antigen
D) liver function tests and full blood count
E) lipid profile and liver function tests

5. A 37-year-old woman presented with a 2-year history of increasingly frequent flushing episodes. She described alternating loose bowel motions and constipation. She had also noted menstrual irregularity. She had no respiratory symptoms. She denied headache or chest pain, but complained of palpitations.
On examination, she appeared well. Her blood pressure was 128/82 mmHg.
Investigations:
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next investigation?

A) plasma metanephrines
B) urinary metanephrines
C) urinary 5-hydroxyindoleacetic acid
D) serum gonadotrophins
E) fasting plasma gut hormones

Solutions: