MRCPUK SEND Exam Syllabus Topics:

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

1. A 25-year-old woman with type 1 diabetes mellitus presented with light-headedness, nausea, thirst and vomiting of 3 days' duration. She was fully conscious.
On examination, her pulse was 104 beats per minute and her blood pressure was 104/64 mmHg. Urinalysis showed glucose 2+, ketones 3+.
Investigations:
serum sodium150 mmol/L (137-144)
serum potassium5.5 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107)
serum urea5.0 mmol/L (2.5-7.0)
serum creatinine90 umol/L (60-110)
random plasma glucose20.0 mmol/L
arterial blood gases, breathing air:
PO212.4 kPa (11.3-12.6)
PCO23.4 kPa (4.7-6.0)
pH7.15 (7.35-7.45)
H+70 nmol/L (35-45)
bicarbonate6 mmol/L (21-29)
What intravenous fluid should be given over the first 30 minutes?

A) sodium chloride 0.45%
B) sodium chloride 0.9%
C) colloid solution
D) compound sodium lactate
E) sodium chloride 0.18% and glucose 4%

2. An 18-year-old woman was found to have a blood pressure of 164/102 mmHg at a preemployment medical examination. She gave no family history of hypertension. On enquiry, she said that she had not yet started to menstruate.
On initial clinical examination, she appeared well. She was 1.72 m tall (>90th centile) and had a body mass index of 22 kg/m2 (18-25). There was no evidence of axillary hair, and pubic hair was scanty (Tanner stage 1). Breast development was immature (Tanner stage 1).
Investigations:
serum sodium142 mmol/L (137-144)
serum potassium2.7 mmol/L (3.5-4.9)
serum urea4.6 mmol/L (2.5-7.0)
serum creatinine102 umol/L (60-110)
estimated glomerular filtration rate (MDRD)>60 mL/min/1.73 m2 (>60)
plasma renin activity (after 30 min supine)1.0 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)125 pmol/L (135-400)
serum cortisol (09.00 h)190 nmol/L (200-700)
What is the most likely underlying diagnosis?

A) adrenal 21-hydroxylase deficiency
B) adrenal 17-hydroxylase deficiency
C) 11-hydroxysteroid dehydrogenase type 2 deficiency
D) adrenal 11-hydroxylase deficiency
E) deoxycorticosterone-secreting adrenal tumour

3. A 23-year-old man presented with a history of discomfort with his gender for as long as he could remember. He believed he was transsexual.
What element of further history would most strongly support his self-diagnosis?

A) conscious and absolute rejection of his sexual orientation as socially unacceptable
B) a long-standing intense wish to make his body conform to that of the preferred gender
C) seeking medical rationalisation for sexuality through genital surgery
D) sexual excitement by cross-dressing
E) the presence of gender somatic delusions that emerge and strengthen with time

4. A 39-year-old woman with Graves' disease was considered suitable for treatment with radioiodine. She was keen that her thyrotoxicosis should not recur. The plan was to request a 600 MBq dose.
What is the probability of resolution of thyrotoxicosis with this dose?

A) 20%
B) 40%
C) >95%
D) 80%
E) 60%

5. A 45-year-old woman was found to be hypertensive by her general practitioner. She was otherwise well and was not taking any medication. However, she regularly ate health food containing liquorice. There was no family history of significant illness.
On examination, her blood pressure was 170/110 mmHg.
Investigations:
serum sodium140 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine70 umol/L (60-110)
plasma renin activity (after 30 min supine)0.5 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)450 pmol/L (135-400)
During the investigations, her blood pressure was controlled with doxazosin. What is the most likely diagnosis?

A) pseudohyperaldosteronism
B) Gitelman's syndrome
C) primary hyperaldosteronism
D) renal artery stenosis
E) apparent mineralocorticoid excess

Solutions: