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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

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

Question 2

A 55-year-old woman presented complaining of difficulty losing weight.
On examination, her blood pressure was 170/105 mmHg and urinalysis showed protein 1+.
An ultrasound scan of abdomen revealed a 4.5-cm solid lesion in the right adrenal gland. She was treated with ramipril and further endocrine evaluation was performed.
Investigations:
serum potassium3.6 mmol/L (3.5-4.9)
serum creatinine135 umol/L (60-110)
plasma renin activity:
(after 30 min supine)3.9 pmol/mL/h (1.1-2.7)
(after 30 min upright)6.8 pmol/mL/h (3.0-4.3)
plasma aldosterone:
(after 30 min supine)150 pmol/L (135-400)
(after 4 h upright)350 pmol/L (330-830)
serum cortisol (09.00 h)650 nmol/L (200-700)
serum cortisol (22.00 h)225 nmol/L (50-250)
24-h urinary free cortisol230 nmol (55-250)
24-h urinary dopamine3200 nmol (<3100)
24-h urinary adrenaline120 nmol (<144)
24-h urinary noradrenaline450 nmol (<570)
What is the most appropriate initial management of the adrenal lesion?

A. mineralocorticoid receptor blockade
B. angiotensin-2 receptor blockade
C. medical observation with annual ultrasonography
D. surgical excision
E. ?-adrenoceptor blockade

Question 3

A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty.
Clinical examination showed central obesity, a body mass index of 32 kg/m2 (18-25) and a blood pressure of 140/90 mmHg.
The following results were obtained within 1 week of her last menstrual period.
Investigations:
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol30 nmol/L (<50)
serum dehydroepiandrosterone sulphate12 umol/L (3-12)
serum androstenedione10.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone38 nmol/L (1-10)
serum oestradiol200 pmol/L (200-400)
serum testosterone3.5 nmol/L (0.5-3.0)
serum sex hormone binding globulin30 nmol/L (40-137)
plasma follicle-stimulating hormone4.0 U/L (2.5-10.0)
plasma luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?

A. Cushing's syndrome
B. late-onset congenital adrenal hyperplasia
C. ovarian androgen-secreting tumour
D. adrenal androgen-secreting tumour
E. polycystic ovary syndrome

Question 4

A 50-year-old woman noticed some swelling of her right great toe and a painful right foot. She had type 1 diabetes mellitus of 21 years' duration and recent screening had revealed some mild diabetic retinal changes and peripheral neuropathy.
On examination, she had a hot, red right forefoot with swelling of the great toe. There was callus on the first metatarsal head with a blister beneath it. After de-roofing, the podiatrist probed to a depth of 1 cm. The left foot demonstrated reduced sensation to a 10-g monofilament. Her right foot was 0.6C hotter than the left.
What is the most likely diagnosis?

A. Charcot's foot
B. necrotising fasciitis
C. gout
D. osteomyelitis
E. osteoarthritis

Question 5

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

Solutions: