MRCPUK SEND Actual Tests : 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 53-year-old man with a history of sweats and tremor was found to have abnormal thyroid function tests and a small diffuse goitre. He was treated with carbimazole 20 mg but developed a sore throat after 3 weeks.
Investigations:
haemoglobin150 g/L (130-180)
white cell count2.0 ? 109/L (4.0-11.0)
neutrophil count0.4 ? 109/L (1.5-7.0)
serum thyroid-stimulating hormone<0.02 mU/L (0.4-5.0)
serum free T429.0 pmol/L (10.0-22.0)
thyrotropin receptor antibodiespositive
The carbimazole was stopped; his sore throat resolved and the full blood count normalised.
What is the most appropriate next step in management?

A) treat with Lugol's iodine 5 drops three times daily for 6 months
B) start propylthiouracil 100 mg twice daily
C) restart carbimazole 5 mg daily
D) early radioactive iodine therapy
E) early partial thyroidectomy

2. A 32-year-old man presented to the emergency department after becoming acutely unwell. He had a 5-year history of type 1 diabetes mellitus and no other significant medical history.
On examination, he was apyrexial, his pulse was 120 beats per minute, his blood pressure was 96/58 mmHg and his respiratory rate was 32 breaths per minute.
Investigations:
random plasma glucose14.2 mmol/L
arterial blood gases, breathing 60% oxygen:
PO28.9 kPa (11.3-12.6)
PCO22.6 kPa (4.7-6.0)
pH7.10 (7.35-7.45)
H+79 nmol/L (35-45)
bicarbonate6.1 mmol/L (21-29)
base excess-18 mmol/L (+-2)
What diagnosis is most likely to account for these results?

A) diabetic ketoacidosis
B) diabetic ketoacidosis and pulmonary embolism
C) acute myocardial infarction
D) salicylate poisoning
E) acute asthma

3. A 64-year-old man presented with palpitations, fatigue and malaise. Two months previously, he had sustained an acute myocardial infarction complicated by ventricular tachycardia and cardiac arrest, and had been discharged taking amiodarone 200 mg daily.
On examination, he appeared well, his pulse was 90 beats per minute and regular, and he
had mild tremor of his hands but no other abnormal signs.
Investigations:
serum thyroid-stimulating hormone6.2 mU/L (0.4-5.0)
serum free T418.2 pmol/L (10.0-22.0)
serum free T34.8 pmol/L (3.0-7.0)
What is the most appropriate next step in management?

A) repeat thyroid function tests in 2 months
B) isotope scan of thyroid
C) repeat thyroid function tests in 12 months
D) start levothyroxine
E) discontinue amiodarone

4. A 24-year-old woman presented with a 1-year history of secondary amenorrhoea. She also complained of milky discharge from her breasts. She was otherwise well, but had been having difficulty getting pregnant despite regular sexual intercourse. She was taking no medication.
Investigations:
serum prolactin3214 mU/L (<360)
serum thyroid-stimulating hormone2.4 mU/L (0.4-5.0)
serum free T415.6 pmol/L (10.0-22.0)
MR scan of pituitary7-mm left-sided pituitary mass
with no extension beyond the sella
What is the most appropriate licensed therapy in the UK to assist conception?

A) quinagolide
B) cabergoline
C) clomifene
D) gonadotropin therapy
E) bromocriptine

5. A 17-year-old boy, with short stature, obesity and neurobehavioural problems, was referred because of cold intolerance.
On examination, he and his mother had similar body habitus and short fingers (brachydactyly).
Investigations (before attending clinic):
serum sodium143 mmol/L (137-144) serum potassium4.4 mmol/L (3.5-4.9) serum creatinine93 umol/L (60-110) serum corrected calcium2.02 mmol/L (2.20-2.60) serum phosphate1.7 mmol/L (0.8-1.4)
serum thyroid-stimulating hormone16.0 mU/L (0.4-5.0) serum free T410.0 pmol/L (10.0-22.0) plasma parathyroid hormone27.0 pmol/L (0.9-5.4)
His mother's blood tests were all normal.
What is the most likely diagnosis in this boy?

A) pseudopseudohypoparathyroidism
B) polyglandular autoimmune syndrome type 1
C) DiGeorge syndrome
D) pseudohypoparathyroidism
E) McCune-Albright syndrome

Solutions: