MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) - SEND certification

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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

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. androgen abuse
C. primary hypogonadotrophic hypogonadism
D. persistence of pubertal gynaecomastia
E. alcohol excess

Question 2

A 40-year-old man presented with a 4-month history of increasing central obesity. His medical history included HIV infection and allergic rhinitis. He was taking highly active antiretroviral therapy and nasal fluticasone.
On examination, he had marked central adiposity. His blood pressure was 160/95 mmHg.
Investigations:
serum sodium140 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum cholesterol5.5 mmol/L (<5.2)
fasting serum triglycerides8.20 mmol/L (0.45-1.69)
serum cortisol (09.00 h)<50 nmol/L (200-700)
serum thyroid-stimulating hormone4.6 mU/L (0.4-5.0)
serum free T49.3 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A. HIV-associated lipodystrophy
B. Cushing's syndrome
C. Addison's disease
D. hypothyroidism
E. glucocorticoid resistance

Question 3

A 46-year-old man of European descent was reviewed in the diabetes clinic. He had type 2 diabetes mellitus, which had been diagnosed 6 months previously. He had been symptom free and was a non-smoker but had a family history of cardiovascular disease. He exercised regularly and had managed to lose 8 kg.
On examination, his blood pressure was 148/76 mmHg, his weight was 76 kg and his body mass index was 24 kg/m2 (18-25).
Investigations:
urinary albumin:creatinine ratio0.6 mg/mmol (<2.5)
serum cholesterol5.6 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.20 mmol/L (0.45-1.69)
According to NICE guidelines (CG181, July 2014), what is the most appropriate management of his lipid profile?

A. start a fibrate
B. assess cardiovascular risk using UKPDS risk engine
C. observe and repeat lipid profile in a few months
D. start nicotinic acid
E. start a statin

Question 4

A 27-year-old woman with type 1 diabetes mellitus was invited to attend a structured education (e.g. DAFNE) coursE.
Which quality of life domain is most affected when a person is found to have type 1 diabetes mellitus?

A. working life and work-related opportunities
B. family life
C. sex life
D. enjoyment of leisure activities
E. freedom to eat as one wishes

Question 5

Carbimazole is routinely used in the management of thyroid disease.
What does carbimazole inhibit?

A. thyroid peroxidase
B. sodium/iodide symporter
C. presentation of thyroid antigens to autoreactive T cells
D. thyroglobulin synthesis
E. deiodinase type 1

Solutions: