MRCPUK SEND

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MRCPUK SEND Exam Syllabus Topics:

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

1. A 15-year-old boy was referred by the school nurse because she was concerned about his weight. There was no past history of note. He was not taking any medication. His height was 1.61 m and he weighed 70.5 kg.
Investigations: growth chartsee image

What is the most likely diagnosis?

A) Cushing's disease
B) leptin deficiency
C) Prader-Willi syndrome
D) growth hormone deficiency
E) simple obesity

2. A 25-year-old woman presented at 28 weeks' gestation after a screening 75-g oral glucose tolerance test, which had shown a fasting plasma glucose of 5.6 mmol/L (3.0-6.0) and a 2h plasma glucose of 9.8 mmol/L (<7.8). She had a family history of type 2 diabetes mellitus and a pre-pregnancy body mass index of 36 kg/m2 (18-25). Home blood glucose monitoring had shown persistently raised blood glucose despite dietary modification. She refused insulin because of needle phobia and was concerned about drug exposure to her unborn child.
The use of what hypoglycaemic therapy is acceptable in this situation?

A) glibenclamide
B) gliclazide
C) sitagliptin
D) exenatide
E) pioglitazone

3. A 48-year-old man was referred by his general practitioner, whose letter stated: 'Please review this man's blood pressure management, as he has requested a second opinion, having seen information on the internet about the need for more detailed investigation. He has been having treatment for 10 years.'
At the consultation, the patient confirmed that he was currently taking bendroflumethiazide
2.5 mg daily, atenolol 50 mg daily and perindopril 8 mg daily. His clinic blood pressure was 169/108 mmHg. Clinical examination was otherwise normal.
Investigations:
serum sodium142 mmol/L (137-144)
serum potassium3.9 mmol/L (3.5-4.9)
estimated glomerular filtration rate (MDRD)>60 mL/min/1.73 m2 (>60)
ambulant plasma renin activity0.5 pmol/mL/h (3.0-4.3)
ambulant plasma aldosterone380 pmol/L (330-830)
What is the most appropriate next step in management?

A) add amlodipine
B) withdraw atenolol and repeat renin and aldosterone
C) CT scan of adrenal glands
D) fludrocortisone suppression test
E) urine steroid profile

4. A 52-year-old man, with a 20-year history of type 2 diabetes mellitus, had been treated with metformin and, for the previous 4 years, biphasic insulin aspart twice daily. He had recently started a new job that required him to drive a 7.5-tonne vehicle.
If he were to apply for a UK Class C1 driving licence, who should complete the application form with him?

A) general practitioner
B) diabetes specialist nurse in secondary care
C) consultant physician specialising in diabetes
D) occupational health physician
E) solicitor

5. A 56-year-old woman presented with a swelling in her neck, which she had noticed by chance 6 weeks previously. The swelling had not changed in size since she first noticed it, and was completely asymptomatic.
On examination, there was a smooth nodule in the thyroid that moved up on swallowing and there was no lymphadenopathy.
Investigations:
ultrasound scan of thyroidsingle 4.7-cm hypoechoic nodule
in upper left lobe
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next step in management?

A) fine-needle aspiration for cytology
B) hemithyroidectomy
C) isotope uptake scan
D) serial ultrasound examinations
E) FDG-PET CT scan

Solutions: