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MRCPUK SEND Exam Syllabus Topics:

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

1. An 18-year-old man presented with delayed puberty.
On examination, he had a high arched palate. His sense of smell was intact, and he had a
family history of pubertal delay. Kallman's syndrome was suspected.
Investigations:
serum testosterone0.3 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.0 U/L (1.0-10.0)
bone age15 years
What further clinical finding would most strongly support the diagnosis of Kallman's
syndrome?

A) eunuchoid habitus
B) short stature
C) testes 6 mL bilaterally
D) bimanual synkinesia (mirror movements)
E) night blindness

2. A 62-year-old woman was referred with difficulty in swallowing and a painful, swollen neck.
On examination, her neck was tender to palpation with a small, diffuse goitre. There was no
associated neck lymphadenopathy.
Investigations:
serum thyroid-stimulating hormone<0.04 mU/L (0.4-5.0)
serum free T426.0 pmol/L (10.0-22.0)
serum free T312.0 pmol/L (3.0-7.0)
What is the most likely diagnosis?

A) thyroid carcinoma
B) haemorrhage into a thyroid cyst
C) toxic adenoma
D) subacute thyroiditis
E) Graves' disease

3. A pregnant 36-year-old woman presented to the diabetes outpatient clinic. She had type 2
diabetes mellitus treated with diet, lifestyle changes and metformin 500 mg twice daily.
On examination, her blood pressure was 128/84 mmHg.
Investigations:
haemoglobin A1c47 mmol/mol (20-42)
urinary albumin:creatinine ratio1.6 mg/mmol (<3.5)
Which is the best agent to reduce the risk of pre-eclampsia in this patient?

A) aspirin
B) omega-3-marine triglycerides
C) labetalol
D) insulin
E) folic acid

4. A 28-year-old Asian woman was seen in the joint diabetes-antenatal clinic at 16 weeks' gestation. She gave a history of gestational diabetes during her previous pregnancy. She had a strong family history of diabetes mellitus. She was fit and well, and had no symptoms other than slight early morning sickness.
According to NICE guidance (NG3, February 2015) for management of pregnancy, what is the most appropriate way to screen for gestational diabetes in this woman?

A) fasting plasma glucose
B) oral glucose tolerance test at 24-28 weeks' gestation
C) oral glucose tolerance test as soon as possible
D) haemoglobin A1c
E) 2-h postprandial plasma glucose

5. A 26-year-old physiologist was seen in the diabetes outpatient clinic. She had type 1 diabetes mellitus of 9 months' duration, treated with subcutaneous insulin.
She asked what symptoms of hypoglycaemia she might experience.
In what order are responses to hypoglycaemia most likely to occur as blood glucose falls?

A) neuroglycopenia, autonomic, counter-regulatory hormones
B) autonomic, neuroglycopenia, counter-regulatory hormones
C) counter-regulatory hormones, autonomic, neuroglycopenia
D) autonomic, counter-regulatory hormones, neuroglycopenia
E) counter-regulatory hormones, neuroglycopenia, autonomic

Solutions: