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MRCPUK SEND Exam Syllabus Topics:

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

1. A 62-year-old woman was admitted with right lower lobe pneumonia. She was taking
amiodarone for atrial fibrillation. Routine thyroid function tests were performed.
Investigations:
serum thyroid-stimulating hormone0.3 mU/L (0.4-5.0)
serum free T427.0 pmol/L (10.0-22.0)
serum free T34.2 pmol/L (3.0-7.0)
anti-thyroid peroxidase antibodies32 IU/mL (<50)
What is the most appropriate interpretation of the thyroid function tests?

A) Wolff-Chaikoff effect
B) amiodarone-induced thyrotoxicosis type II
C) amiodarone-induced thyrotoxicosis type I
D) subclinical amiodarone-induced thyrotoxicosis
E) amiodarone effect in a euthyroid patient

2. A 25-year-old woman with type 1 diabetes mellitus presented with light-headedness, nausea, thirst and vomiting of 3 days' duration. She was fully conscious.
On examination, her pulse was 104 beats per minute and her blood pressure was 104/64 mmHg. Urinalysis showed glucose 2+, ketones 3+.
Investigations:
serum sodium150 mmol/L (137-144)
serum potassium5.5 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107)
serum urea5.0 mmol/L (2.5-7.0)
serum creatinine90 umol/L (60-110)
random plasma glucose20.0 mmol/L
arterial blood gases, breathing air:
PO212.4 kPa (11.3-12.6)
PCO23.4 kPa (4.7-6.0)
pH7.15 (7.35-7.45)
H+70 nmol/L (35-45)
bicarbonate6 mmol/L (21-29)
What intravenous fluid should be given over the first 30 minutes?

A) colloid solution
B) sodium chloride 0.18% and glucose 4%
C) sodium chloride 0.9%
D) sodium chloride 0.45%
E) compound sodium lactate

3. An 18-year-old woman was found to have a blood pressure of 164/102 mmHg at a preemployment medical examination. She gave no family history of hypertension. On enquiry, she said that she had not yet started to menstruate.
On initial clinical examination, she appeared well. She was 1.72 m tall (>90th centile) and had a body mass index of 22 kg/m2 (18-25). There was no evidence of axillary hair, and pubic hair was scanty (Tanner stage 1). Breast development was immature (Tanner stage 1).
Investigations:
serum sodium142 mmol/L (137-144)
serum potassium2.7 mmol/L (3.5-4.9)
serum urea4.6 mmol/L (2.5-7.0)
serum creatinine102 umol/L (60-110)
estimated glomerular filtration rate (MDRD)>60 mL/min/1.73 m2 (>60)
plasma renin activity (after 30 min supine)1.0 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)125 pmol/L (135-400)
serum cortisol (09.00 h)190 nmol/L (200-700)
What is the most likely underlying diagnosis?

A) deoxycorticosterone-secreting adrenal tumour
B) adrenal 17-hydroxylase deficiency
C) 11-hydroxysteroid dehydrogenase type 2 deficiency
D) adrenal 11-hydroxylase deficiency
E) adrenal 21-hydroxylase deficiency

4. A 72-year-old man with a dense residual hemiparesis and unsafe swallow was fed via a percutaneous gastrostomy for 20 hours each day. He had type 2 diabetes mellitus that had been well controlled with metformin.
His glucose levels were uncontrolled on metformin powder at maximum dose.
According to the Joint British Diabetes Societies Guidelines (2012), what is the most appropriate next hypoglycaemic agent?

A) premixed (30/70) human insulin
B) exenatide
C) insulin glargine
D) gliclazide
E) insulin detemir

5. A 35-year-old woman with a 12-year history of type 1 diabetes mellitus was reviewed in the multidisciplinary pump clinic, because her diabetes was treated with an insulin pump. She had a group 2, C1 lorry-driving licence.
Specific driving-related questioning showed that she kept fast-acting carbohydrate in her vehicles and she reported good hypoglycaemic warnings. Data downloaded from her pump indicated significant variability in her blood glucose readings with few results below 2 mmol/L. She declared that this happened occasionally and she was able to explain the events.
According to implementation by the UK of the Third European Union Directive on driving, what is the most appropriate advice?

A) she can continue to drive
B) she must appear before a Driver and Vehicle Licensing Agency-accredited diabetes specialist for assessment within 1 month
C) she should stop driving voluntarily until blood glucose levels increase
D) she must surrender her licence for 6 months
E) her licence must be surrendered immediately until further assessment

Solutions: