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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

A 27-year-old woman was referred with abnormal thyroid function tests. She was well and reported no symptoms of thyroid disease apart from occasional palpitations. Her sister had been investigated for a thyroid problem recently. The patient was taking no medication.
Examination was normal.
Investigations:
serum thyroid-stimulating hormone7.6 mU/L (0.4-5.0) serum free T4 28.5 pmol/L (10.0-22.0)
serum free T3 13.6 pmol/L (3.0-7.0)
Her results were confirmed and no evidence of assay interference was reported by the clinical chemist, who indicated that similar thyroid function tests had been obtained 5 years previously.
MR scan of pituitarynormal
What is the most appropriate next investigation?

A. iodine uptake scan
B. thyrotropin-releasing hormone test
C. sequencing the thyroid-stimulating hormone receptor gene
D. serum thyroglobulin
E. sequencing the ?-subunit of the thyroid hormone receptor gene

Question 2

A 52-year-old woman had been found to have type 2 diabetes mellitus approximately 6
months previously.
Investigations:
haemoglobin A1c50 mmol/mol (20-42)
What is the lifetime risk of her identical twin sister also developing type 2 diabetes mellitus?

A. >60%
B. 20-30%
C. 5-10%
D. <5%
E. 40-50%

Question 3

A 26-year-old man presented urgently, complaining of muscle pains. He had been found to have heterozygous familial hypercholesterolaemia 2 years previously owing to a mutation in the PCSK9 gene. He had a strong family history of premature vascular disease. He was taking atorvastatin 80 mg daily.
Investigations:
serum creatine kinase2782 U/L (24-195)
serum cholesterol5.7 mmol/L (<5.2)
After stopping atorvastatin, his serum creatine kinase fell to within the normal range.
What is the most appropriate next step in management?

A. start fluvastatin 40 mg
B. restart atorvastatin 10 mg
C. restart atorvastatin 40 mg
D. start fenofibrate 100 mg
E. start ezetimibe 10 mg

Question 4

A 62-year-old man was referred from the infectious diseases clinic. He had HIV infection and was taking treatment that included thymidine analogue nucleoside reverse transcriptase inhibitors. He had developed considerable loss of limb and gluteal subcutaneous fat. He had complained recently of polyuria and polydipsia and was found to have a fasting plasma glucose of 8.3 mmol/L (3.0-6.0).
What is the most appropriate treatment for his diabetes mellitus?

A. insulin
B. exenatide
C. gliclazide
D. pioglitazone
E. metformin

Question 5

A 64-year-old woman presented with features of acromegaly. An MR scan showed a pituitary tumour with cavernous sinus extension. She underwent trans-sphenoidal surgery and histology of the pituitary tissue showed numerous cells immunostaining for growth hormone.
Investigations (6 months postoperatively):
MR scan of pituitaryenlarged sella, residual tumour in right cavernous sinus
serum growth hormone (day curve average)3.2 ?g/L (<2)
serum insulin-like growth factor 142.0 nmol/L (3.3-23.3)
What is the most appropriate next step in management?

A. repeat trans-sphenoidal surgery
B. conventional external beam radiotherapy to pituitary region
C. watchful waiting
D. long-acting octreotide
E. pegvisomant

Solutions: