MRCPUK SEND : Endocrinology and Diabetes (Specialty Certificate Examination)

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MRCPUK SEND Exam Syllabus Topics:

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

1. A 48-year-old man with an 8-year history of type 2 diabetes mellitus was referred because of poor glycaemic control. He had a history of myocardial infarction complicated by previous congestive cardiac failure. His current medication comprised metformin 850 mg three times daily and gliclazide 80 mg once daily. He had gained weight and his body mass index was 31 kg/m2 (18-25).
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine136 umol/L (60-110)
haemoglobin A1c74 mmol/mol (20-42)
According to NICE guidelines (CG87, May 2009), what is the most appropriate immediate next step in management to improve his glycaemic control?

A) increase the dose of gliclazide
B) add sitagliptin
C) add exenatide
D) add pioglitazone
E) start insulin treatment

2. A 29-year-old woman presented with primary infertility, having had unprotected sexual intercourse for 15 months. Menarche had occurred at the age of 13.5 years. Her menstrual cycle was irregular, occurring every 20-60 days. There was no history of galactorrhoea. She denied abnormal hair growth.
On examination, her body mass index was 28.9 kg/m2 (18-25) and she had normal secondary sexual characteristics. Her visual fields were full to confrontation.
Investigations:
serum androstenedione12.8 nmol/L (0.6-8.8)
serum oestradiol205 pmol/L (200-400)
serum testosterone2.4 nmol/L (0.5-3.0)
serum sex hormone binding globulin23 nmol/L (40-137)
serum follicle-stimulating hormone4.3 U/L (2.5-10.0)
serum luteinising hormone8.5 U/L (2.5-10.0)
serum prolactin420 mU/L (<360)
hysterosalpingogrampatent fallopian tubes
partner's semen analysisnormal sperm count and motility
What is the most appropriate first-line intervention?

A) cabergoline
B) orlistat
C) metformin
D) human menopausal gonadotropins
E) human chorionic gonadotropin

3. A 16-year-old boy was referred to the endocrine clinic. He was concerned about his growth and pubertal development. He was well with no significant medical history. He had felt his development had lagged behind his peers for the previous 2 years and he had been the shortest in his class for some time and was being bullied.
General examination was normal. His height was 1.53 m and weight 52.4 kg. He had Tanner stage 3 genitalia and pubic hair. Axillary hair was present. Testicular volumes were 6 mL bilaterally.
Investigations:
serum testosterone4.4 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone2.5 U/L (1.0-7.0)
plasma luteinising hormone1.8 U/L (1.0-10.0)
serum insulin-like growth factor 134.5 nmol/L (9.3-56.0)
insulin tolerance test:

What is the most appropriate treatment?

A) reassure and review
B) hydrocortisone 15 mg am, 5 mg pm
C) testosterone 250 mg intramuscularly per month
D) testosterone 50 mg intramuscularly per month
E) growth hormone 0.4 mg subcutaneously per day

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

5. A 20-year-old man presented with a 6-month history of lethargy and weakness. His brother had been found to have adrenal failure at the age of 18. He had two sisters who were well and there was no other family history of endocrine autoimmune disease.
On examination, his blood pressure was 100/60 mmHg.
Investigations:
serum sodium136 mmol/L (137-144)
serum potassium4.8 mmol/L (3.5-4.9)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol100 nmol/L
serum cortisol (30 min after tetracosactide)250 nmol/L (>550)
anti-adrenal antibodiesnegative
What is the most important diagnosis to consider?

A) familial glucocorticoid resistance
B) isolated adrenocorticotropic hormone deficiency
C) autoimmune hypoadrenalism
D) tuberculosis
E) adrenoleucodystrophy

Solutions: