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MRCPUK SEND Exam Syllabus Topics:

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

1. A 78-year-old man presented with confusion, lethargy and thirst. He had hypertension treated with lisinopril 20 mg daily.
On examination, he was dehydrated. His pulse was 110 beats per minute and his blood pressure was 84/40 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium155 mmol/L (137-144) serum potassium5.2 mmol/L (3.5-4.9) serum bicarbonate17 mmol/L (20-28) serum urea40.0 mmol/L (2.5-7.0)
serum creatinine358 umol/L (60-110) random plasma glucose78.0 mmol/L He was treated with sodium chloride 0.9%. After 8 hours' treatment, his urine output was
10 mL/h and his blood pressure was 121/50 mmHg. Investigations (after 8 hours' treatment): serum sodium151 mmol/L (137-144)
serum potassium4.9 mmol/L (3.5-4.9) serum bicarbonate18 mmol/L (20-28) serum urea39.0 mmol/L (2.5-7.0) serum creatinine347 umol/L (60-110)
random plasma glucose48.0 mmol/L
What is the most appropriate next step in management?

A) sodium chloride 0.45%
B) compound lactate solution (Hartmann's solution)
C) sodium chloride 0.18% and glucose 4%
D) sodium chloride 0.9%
E) sodium chloride 0.18% and glucose 5%

2. A 48-year-old man presented with an infected ulcer, measuring 2 ? 1 cm, over the right first metatarsal head, with surrounding cellulitis. He had no previous history of diabetes mellitus but had been told by his general practitioner some years previously that his blood glucose was 'borderline'.
On examination, his temperature was 37.4C, his blood pressure was 158/92 mmHg and his body mass index was 31.5 kg/m2 (18-25). His foot pulses were easily palpable but he had a sensory neuropathy.
Investigations:
random plasma glucose16.4 mmol/L
haemoglobin A1c81 mmol/mol (20-42)
What is the most appropriate treatment for his hyperglycaemia?

A) sitagliptin 100 mg once daily
B) gliclazide 40 mg twice daily
C) exenatide 5 micrograms twice daily
D) metformin 500 mg twice daily
E) soluble insulin before meals, basal insulin at bedtime

3. A 64-year-old man was referred to the foot clinic. He had tripped over his cat 1 week previously and had complained of an ache in his left foot since then. He had a 12-year history of type 2 diabetes mellitus and hypertension. He was taking metformin, gliclazide, pioglitazone, bendroflumethiazide, ramipril, simvastatin and aspirin.
On examination, his blood pressure was 154/88 mmHg. Foot examination showed absent vibration perception to his ankle. The dorsalis pedis and posterior tibial pulses were easily palpable on both feet.
Investigations:
serum urea12.6 mmol/L (2.5-7.0) serum creatinine166 umol/L (60-110) haemoglobin A1c79 mmol/mol (20-42)
urinary albumin:creatinine ratio8.7 mg/mmol (<2.5)
X-ray of left footsee image

What is the most appropriate initial management for this deformity?

A) removable aircast boot
B) full contact plaster cast
C) referral for urgent surgery
D) bed rest
E) custom-made hospital footwear

4. A 37-year-old woman presented with a 2-year history of increasingly frequent flushing episodes. She described alternating loose bowel motions and constipation. She had also noted menstrual irregularity. She had no respiratory symptoms. She denied headache or chest pain, but complained of palpitations.
On examination, she appeared well. Her blood pressure was 128/82 mmHg.
Investigations:
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next investigation?

A) serum gonadotrophins
B) fasting plasma gut hormones
C) urinary metanephrines
D) urinary 5-hydroxyindoleacetic acid
E) plasma metanephrines

5. A 48-year-old man presented with gynaecomastia. His serum oestradiol was increased and a CT scan of adrenal glands revealed a 13-cm tumour of the left adrenal gland. Further workup showed increased secretion of 17-hydroxyprogesterone, cortisol and androstenedione. A diagnosis of adrenocortical carcinoma was suspected.
Investigations:
staging CT scan of chest and abdomenno evidence of metastasis
What is the most appropriate next step in management?

A) iodocholesterol scan
B) left adrenalectomy followed by adjuvant combination chemotherapy
C) adrenal fine-needle biopsy
D) MR scan of adrenal glands with chemical shift analysis
E) left adrenalectomy followed by adjuvant mitotane treatment

Solutions: