MRCPUK SEND Valid Test : Endocrinology and Diabetes (Specialty Certificate Examination)

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MRCPUK SEND Exam Syllabus Topics:

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

1. A 30-year-old man was reviewed in the diabetes clinic. He had type 1 diabetes mellitus of 6 months' duration, treated with subcutaneous insulin in a basal bolus regimen (short-acting insulin three times daily; long-acting insulin once daily).
Investigations:
haemoglobin A1c52 mmol/mol (20-42)
At what arterialised venous blood glucose threshold would a patient typically expect to develop neuroglycopenic symptoms?

A) 3.5-3.9 mmol/L
B) <2.3 mmol/L
C) 2.7-3.0 mmol/L
D) 3.1-3.4 mmol/L
E) 2.3-2.6 mmol/L

2. A 50-year-old Asian woman with an 18-year history of type 2 diabetes mellitus complained of discomfort and mild swelling in her left foot after tripping on a pavement. She was being treated with metformin, gliclazide and pioglitazone.
On examination, her foot was warm and slightly oedematous over the dorsum but not discoloured. She was afebrile and the foot pulses were bounding. Tendon reflexes in the legs were absent and vibration perception diminished. Urinalysis showed protein 2+, glucose 1+.
Investigations:
white cell count5.2 ? 109/L (4.0-11.0)
serum creatinine140 umol/L (60-110)
haemoglobin A1c63 mmol/mol (20-42)
X-ray of left footnormal bone architecture; some calcification of the arteries
isotope bone scanincreased isotope uptake in the mid-foot only
What is the most effective next step in management?

A) immobilisation in a cast
B) co-amoxiclav
C) celecoxib
D) alendronic acid
E) below-knee removable walking boot

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

4. A 28-year-old woman presented to the emergency department with a 3-day history of abdominal pain. Her past medical history included intermenstrual bleeding, and she was undergoing 6-monthly renal ultrasound surveillance for a cystic lesion.
Investigations:
serum creatinine84 umol/L (60-110)
serum corrected calcium3.20 mmol/L (2.20-2.60)
serum phosphate0.7 mmol/L (0.8-1.4)
plasma parathyroid hormone19.5 pmol/L (0.9-5.4)
What is the most likely condition underlying the clinical presentation?

A) von Hippel-Lindau syndrome
B) multiple endocrine neoplasia type 1
C) multiple endocrine neoplasia type 2B
D) Cowden's syndrome
E) hyperparathyroidism-jaw tumour syndrome

5. A 16-year-old boy was referred with concern about delayed puberty. His stature had been short as a child. He reported an increase in height at the age of 13, and had begun to develop pubic hair at the age of 14. He reported no further growth or development in the past year. His father recalled going through puberty at the age of 13.
On examination, his height was 1.60 m (between 0.4th and 2nd centile), weight was 56.4 kg (between 9th and 25th centile), genital development was Tanner stage 2 and testicular volume was 8 mL bilaterally. Pubic hair was Tanner stage 2, with no evidence of androgenic axillary hair. Bone age at the left wrist was 13.5 years.
Investigations:
serum testosterone2.9 nmol/L (9.0-35.0)
Which feature in his clinical presentation most strongly suggests a diagnosis other than constitutional delay?

A) absence of axillary hair in the presence of pubic hair
B) failure to progress through puberty
C) 2.5-year delay in bone age
D) discordance between the height centile and the weight centile
E) being below the 2nd centile for height

Solutions: