MRCPUK MRCPUK Certification SEND

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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

A 61-year-old woman was found incidentally to have a raised serum calcium concentration. She was otherwise well. Her father had undergone a neck operation many years previously.
Investigations:
serum corrected calcium2.78 mmol/L (2.20-2.60)
plasma parathyroid hormone10.8 pmol/L (0.9-5.4)
Her general practitioner thought she had primary hyperparathyroidism.
Which further finding is most likely to cast doubt upon this diagnosis?

A. low urinary calcium excretion
B. high serum 25-OH-cholecalciferol
C. normal serum phosphate concentration
D. normal parathyroid radioisotope scan (sestamibi scan)
E. low serum magnesium concentration

Question 2

A 52-year-old man had been found to have type 1 diabetes mellitus at the age of 25. He had developed retinopathy at the age of 31 and a painless foot ulcer at the age of 40. His renal function had subsequently deteriorated.
On examination, urinalysis showed protein 1+, glucose 2+.
What is the most likely diagnosis?

A. membranoproliferative glomerulonephritis
B. tubulointerstitial nephritis
C. focal segmental glomerulosclerosis
D. nodular glomerulosclerosis
E. minimal change glomerulonephritis

Question 3

A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty.
Clinical examination showed central obesity, a body mass index of 32 kg/m2 (18-25) and a blood pressure of 140/90 mmHg.
The following results were obtained within 1 week of her last menstrual period.
Investigations:
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol30 nmol/L (<50)
serum dehydroepiandrosterone sulphate12 umol/L (3-12)
serum androstenedione10.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone38 nmol/L (1-10)
serum oestradiol200 pmol/L (200-400)
serum testosterone3.5 nmol/L (0.5-3.0)
serum sex hormone binding globulin30 nmol/L (40-137)
plasma follicle-stimulating hormone4.0 U/L (2.5-10.0)
plasma luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?

A. Cushing's syndrome
B. polycystic ovary syndrome
C. adrenal androgen-secreting tumour
D. ovarian androgen-secreting tumour
E. late-onset congenital adrenal hyperplasia

Question 4

A 67-year-old man underwent an isotope bone scan after being found to have a raised serum alkaline phosphatase (of bone origin). The blood test had been ordered because of mild lower back pain, which had now resolved. He was not taking any medication.
Examination was normal.
Investigations:
isotope bone scansee image

What is the most likely diagnosis?

A. prostate cancer
B. multiple myeloma
C. osteomalacia
D. fibrous dysplasia
E. Paget's disease

Question 5

A 17-year-old boy with a 10-year history of type 1 diabetes mellitus was admitted with diabetic ketoacidosis after a night of binge drinking.
He was treated appropriately with a fixed-rate intravenous insulin infusion and intravenous sodium chloride 0.9%.
Twenty-four hours after admission, he was eating and drinking normally. He was taking his usual doses of subcutaneous insulin and his urinary ketones were undetectable.
Investigations (6 hours previously):
venous blood gases, breathing air: PO25.6 kPa PCO23.8 kPa pH7.29 bicarbonate16 mmol/L base excess-1 mmol/L
lactate1.1 mmol/L
What is the likely most cause of these results?

A. hyporeninaemic hypoaldosteronism
B. continued ketonaemia
C. hyperchloraemia
D. alcohol toxicity
E. concurrent aspirin ingestion

Solutions: