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MRCPUK SEND Exam Syllabus Topics:

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

1. A 60-year-old man with type 2 diabetes mellitus attended for an elective laparoscopic cholecystectomy. His oral hypoglycaemic medication regimen was metformin 1 g twice daily and gliclazide 160 mg twice daily. His haemoglobin A1c concentration had been 69 mmol/mol (20-42) when checked 2 months previously.
He was admitted on the morning of surgery and was on the morning list. He had fasted from midnight and taken metformin 1 g at 05.00 h.
On examination, he weighed 82 kg.
Investigations (on admission):
serum creatinine64 umol/L (60-110)
fasting plasma glucose18.1 mmol/L (3.0-6.0)
capillary blood ketones0.2 mmol/L (<1)
According to the Joint British Diabetes Societies guideline 'Management of adults with diabetes undergoing surgery and elective procedures', what is the most appropriate next step in management to bring his preoperative glucose into the acceptable range (4.0-12.0 mmol/L)?

A) rapid-acting analogue insulin 16 units subcutaneously
B) variable-rate insulin infusion
C) cancel surgery and refer to local diabetes team
D) gliclazide 160 mg orally
E) rapid-acting analogue insulin 8 units subcutaneously

2. A 46-year-old Afro-Caribbean man with sarcoidosis was found to have hypercalcaemia and was treated with prednisolone 20 mg/day. Within 3 weeks his serum calcium had fallen to within the reference range.
How do glucocorticoids reduce serum calcium in sarcoidosis?

A) reduces extrarenal 1-?-hydroxylase activity
B) promote urinary calcium excretion
C) suppress parathyroid hormone secretion
D) increase intravascular fluid volume
E) direct calcium shift into cells

3. A 25-year-old man presented with a 2-month history of thirst and polyuria. He had minimal weight loss and his body mass index was 26 kg/m2 (18-25). He had had sensorineural deafness since childhood. There was a very strong family history of sensorineural deafness and type 2 diabetes mellitus.
Urinalysis showed no ketones.
Investigations:
random plasma glucose18.0 mmol/L
What is the most appropriate next step in management?

A) test for HFE genotype
B) water deprivation test to assess posterior pituitary function
C) test for mitochondrial diabetes
D) genetic testing for maturity-onset diabetes of the young
E) measurement of glutamic acid decarboxylase antibodies

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

5. A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin's lymphoma at the age of 17.
What is the most appropriate investigation?

A) semen analysis
B) serum follicle-stimulating hormone
C) testicular biopsy
D) serum inhibin
E) serum testosterone

Solutions: