Exam Name: Endocrinology and Diabetes (Specialty Certificate Examination)
Certification Provider: MRCPUK
Corresponding Certification: MRCPUK Certification
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- Total Questions: 200
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- Total Questions: 200
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MRCPUK SEND Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Diabetes Mellitus | - Complications
|
| Pituitary and Hypothalamic Disorders | - Pituitary Disease
|
| Reproductive Endocrinology | - Gonadal Disorders
|
| General Endocrinology | - Integrated Clinical Practice
|
| Calcium and Bone Metabolism | - Parathyroid and Metabolic Bone Disease
|
| Thyroid Disorders | - Thyroid Disease
|
| Adrenal Disorders | - Adrenal Disease
|
MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
A 67-year-old woman with type 2 diabetes mellitus presented to the foot clinic with an ulcer at the plantar aspect of her fifth left toe. The ulcer probed to bone but there were no signs of inflammation. There had been a little improvement during 6 weeks of podiatric treatment, but there was some concern about possible osteomyelitis. An X-ray of toe 4 weeks previously had been normal.
What is the most appropriate next investigation?
- A. triple phase isotope bone scan
- B. CT scan of foot
- C. white cell labelled scan
- D. MR scan of foot
- E. plain X-ray of foot
Correct Answer: E 🗳️
A 42-year-old woman, with type 1 diabetes mellitus of 22 years' duration, attended for annual review. She was using biphasic insulin twice daily and taking aspirin 75 mg, simvastatin 40 mg and ramipril 10 mg daily.
On examination, her blood pressure was 164/87 mmHg.
Investigations:
serum potassium5.9 mmol/L (3.5-4.9)
serum creatinine197 umol/L (60-110)
estimated glomerular filtration rate (MDRD)26 mL/min/1.73 m2 (>60)
haemoglobin A1c72 mmol/mol (20-42)
urinary albumin:creatinine ratio27.0 mg/mmol (<3.5)
urine culturenegative
What is the most important next step in management?
- A. check bicarbonate
- B. change to intensive insulin regimen
- C. refer to a nephrologist
- D. add furosemide
- E. add aliskiren
Correct Answer: C 🗳️
A 28-year-old man presented to his optician with a 6-month history of gradually deteriorating vision. He was found to have a visual field defect and was referred urgently to an ophthalmologist who confirmed the finding, and arranged the following investigations.
Investigations (at 09.00 h):
serum cortisol300 nmol/L (200-700) serum testosterone6.5 nmol/L (9.0-35.0) plasma follicle-stimulating hormone1.2 U/L (1.0-7.0) plasma luteinising hormone1.3 U/L (1.0-10.0) serum thyroid-stimulating hormone2.4 mU/L (0.4-5.0) serum free T411.1 pmol/L (10.0-22.0)
What is the most important next investigation?
- A. adrenocorticotropic hormone
- B. random growth hormone
- C. short tetracosactide (Synacthen@) test
- D. prolactin
- E. insulin stress test
Correct Answer: D 🗳️
A 35-year-old woman was referred with a left lower thyroid lesion. She was asymptomatic.
Examination confirmed the presence of a 2 ? 3-cm, firm, mobile, non-tender mass.
Investigations:
ultrasound-guided fine-needle aspiration biopsyThy 5
How is Thy 5 defined?
- A. non-neoplastic (consistent with nodular goitre or thyroiditis)
- B. follicular lesions
- C. non-diagnostic or inadequate
- D. abnormal, diagnostic of malignancy
- E. abnormal, suspicious (but not diagnostic of) malignancy
Correct Answer: D 🗳️
A 55-year-old woman presented complaining of difficulty losing weight.
On examination, her blood pressure was 170/105 mmHg and urinalysis showed protein 1+.
An ultrasound scan of abdomen revealed a 4.5-cm solid lesion in the right adrenal gland. She was treated with ramipril and further endocrine evaluation was performed.
Investigations:
serum potassium3.6 mmol/L (3.5-4.9)
serum creatinine135 umol/L (60-110)
plasma renin activity:
(after 30 min supine)3.9 pmol/mL/h (1.1-2.7)
(after 30 min upright)6.8 pmol/mL/h (3.0-4.3)
plasma aldosterone:
(after 30 min supine)150 pmol/L (135-400)
(after 4 h upright)350 pmol/L (330-830)
serum cortisol (09.00 h)650 nmol/L (200-700)
serum cortisol (22.00 h)225 nmol/L (50-250)
24-h urinary free cortisol230 nmol (55-250)
24-h urinary dopamine3200 nmol (<3100)
24-h urinary adrenaline120 nmol (<144)
24-h urinary noradrenaline450 nmol (<570)
What is the most appropriate initial management of the adrenal lesion?
- A. medical observation with annual ultrasonography
- B. mineralocorticoid receptor blockade
- C. ?-adrenoceptor blockade
- D. surgical excision
- E. angiotensin-2 receptor blockade
Correct Answer: D 🗳️
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