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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

A 26-year-old man presented urgently, complaining of muscle pains. He had been found to have heterozygous familial hypercholesterolaemia 2 years previously owing to a mutation in the PCSK9 gene. He had a strong family history of premature vascular disease. He was taking atorvastatin 80 mg daily.
Investigations:
serum creatine kinase2782 U/L (24-195)
serum cholesterol5.7 mmol/L (<5.2)
After stopping atorvastatin, his serum creatine kinase fell to within the normal range.
What is the most appropriate next step in management?

A. start fenofibrate 100 mg
B. restart atorvastatin 40 mg
C. start ezetimibe 10 mg
D. restart atorvastatin 10 mg
E. start fluvastatin 40 mg

Question 2

A 27-year-old woman presented with a 6-month history of amenorrhoea and low mood. She complained of headaches but no visual disturbance. Her past medical history included anorexia nervosa but her current weight was stable.
On examination, her body mass index was 20.2 kg/m2 (18-25). Routine physical examination was normal and there was no galactorrhoea. Visual fields were full to confrontation.
Investigations:
serum cortisol (09.00 h)320 nmol/L (200-700)
short tetracosactide (Synacthen@) test (250 micrograms): serum cortisol (30 min after tetracosactide)630 nmol/L (>550) serum oestradiol200 pmol/L (200-400) plasma follicle-stimulating hormone2 U/L (2.5-10.0) plasma luteinising hormone4 U/L (2.5-10.0)
serum prolactin1001 mU/L (<360) serum free T418.0 pmol/L (10.0-22.0)
serum ?-human chorionic gonadotropin<5 U/L (<5)
What is the most appropriate next step in management?

A. encourage weight gain and reassess after 2 months
B. pregnancy test
C. start cabergoline 0.5 mg/week
D. ultrasound scan of ovaries
E. MR scan of pituitary

Question 3

A 56-year-old man was referred urgently by an ophthalmologist after presenting with a 6month history of deteriorating vision. The patient had a 40 pack-year smoking history. Before his vision problem, he had never visited his general practitioner.
Investigations:
serum cortisol (09.00 h)389 nmol/L (200-700) serum testosterone8.6 nmol/L (9.0-35.0) plasma follicle-stimulating hormone2.1 U/L (1.0-7.0) plasma luteinising hormone2.4 U/L (1.0-10.0) serum prolactin896 mU/L (<360) serum thyroid-stimulating hormone1.4 mU/L (0.4-5.0)
MR scan of pituitarysee image

What is the most likely diagnosis?

A. Rathke's cyst
B. prolactinoma
C. craniopharyngioma
D. meningioma
E. non-functioning adenoma

Question 4

A 71-year-old man was brought to the emergency department in a collapsed state. He was
unable to give a history. Records showed that he had ischaemic heart disease and had undergone coronary bypass grafting 2 years previously. He was taking bendroflumethiazide 2.5 mg daily and simvastatin 40 mg at bedtime.
On examination he was unwell. His pulse was 128 beats per minute and his blood pressure was 108/60 mmHg. Oxygen saturation was 96% (94-98) breathing air.
An ECG showed Q waves in leads II, III, and aVF.
Investigations:
serum sodium164 mmol/L (137-144)
serum potassium5.4 mmol/L (3.5-4.9)
serum bicarbonate19 mmol/L (20-28)
serum urea15.2 mmol/L (2.5-7.0)
serum creatinine145 umol/L (60-110)
random plasma glucose81.2 mmol/L
What is the most appropriate fluid replacement?

A. sodium chloride 0.9%
B. sodium chloride 0.45%
C. compound sodium lactate intravenous infusion
D. sodium chloride 0.9% and glucose 5%
E. colloid

Question 5

A 42-year-old policewoman presented with thirst, polyuria and tiredness of 3 months' duration. She gave a family history of thyrotoxicosis.
On examination, her pulse was 108 beats per minute and her blood pressure was 150/70 mmHg. She had a fine tremor and diffuse thyroid enlargement. She also had mild proptosis.
Investigations:
haemoglobin146 g/L (115-165)
platelet count164 ? 109/L (150-400)
serum sodium143 mmol/L (137-144)
serum creatinine135 umol/L (60-110)
serum corrected calcium3.60 mmol/L (2.20-2.60)
serum thyroid-stimulating hormone<0.02 mU/L (0.4-5.0)
serum free T431.9 pmol/L (10.0-22.0)
serum free T315.6 pmol/L (3.0-7.0)
What is the most appropriate next investigation?

A. serum phosphate
B. isotope bone scan
C. 24-h urinary calcium
D. fine-needle aspiration of thyroid
E. plasma parathyroid hormone

Solutions: