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MRCPUK SEND Exam Syllabus Topics:

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

1. A 62-year-old man with newly diagnosed type 2 diabetes mellitus presented with weight loss and anaemia.
On examination, the only abnormalities were evidence of recent weight loss and a red-brown rash on his lower limbs. Urinalysis showed glucose 3+.
Investigations:
serum total bilirubin19 umol/L (1-22) serum aspartate aminotransferase26 U/L (1-31) serum alkaline phosphatase98 U/L (45-105) serum gamma glutamyl transferase26 U/L (<50)
plasma gastrin21 pmol/L (<55)
plasma glucagon246 pmol/L (<50)
plasma pancreatic polypeptide158 pmol/L (<300)
plasma vasoactive intestinal polypeptide12 pmol/L (<30)
chromogranin A214 U/L (<40)
serum thyroid-stimulating hormone4.9 mU/L (0.4-5.0)
serum free T49.1 pmol/L (10.0-22.0)
CT scan of abdomen2-cm mass in the tail of the pancreas
What is the most likely explanation for the rash?

A) necrolytic migratory erythema
B) necrobiosis lipoidica diabeticorum
C) acrodermatitis enteropathica
D) pellagra
E) cutaneous metastasis

2. A 36-year-old man of African origin attended the clinic 2 weeks after discharge from hospital following his first admission with diabetic ketoacidosis. He had made a rapid recovery and had been discharged taking subcutaneous insulin twice daily.
At clinic, he reported home blood glucose measurements of 4-6mmol/L, occasional symptomatichypoglycaemia and a total daily insulin dose of 12 units. He asked if his glucose-lowering treatment should change.
Which test is most likely to predict prolonged insulin independence?

A) genotyping for monogenic diabetes
B) anti-islet cell antibodies
C) anti-glutamic acid decarboxylase antibodies
D) glucagon-stimulated C-peptide concentration
E) fasting C-peptide concentration

3. A pregnant 36-year-old woman presented to the diabetes outpatient clinic. She had type 2
diabetes mellitus treated with diet, lifestyle changes and metformin 500 mg twice daily.
On examination, her blood pressure was 128/84 mmHg.
Investigations:
haemoglobin A1c47 mmol/mol (20-42)
urinary albumin:creatinine ratio1.6 mg/mmol (<3.5)
Which is the best agent to reduce the risk of pre-eclampsia in this patient?

A) labetalol
B) aspirin
C) omega-3-marine triglycerides
D) insulin
E) folic acid

4. A 15-year-old boy with a 10-year history of type 1 diabetes mellitus was referred to the adolescent diabetes clinic from the paediatric clinic. Diabetes control had always been satisfactory and his recent haemoglobin A1c concentration was 67 mmol/mol (20-42). He felt generally well, although on a growth chart his weight had fallen steadily from the 50th centile 18 months previously to the 10th centile, and his height had fallen from the 50th centile to the 25th centile. He had stage 4 genital development and stage 4 pubic hair, and testicular volume was 15 mL.
What is the most appropriate investigation?

A) thyroid-stimulating hormone and free thyroxine
B) anti-tissue transglutaminase antibodies
C) short tetracosactide (Synacthen@) test
D) insulin-like growth factor 1
E) serum testosterone

5. A 23-year-old barmaid presented with headache, sweating and collapse. She had a past medical history of tension headache and unexplained abdominal pain. Her regular medication included amitriptyline 25 mg at night and paracetamol 1 g as required. She was a smoker and regularly drank alcohol.
On examination, her pulse was 120 beats per minute and her blood pressure was 210/128 mmHg.
Investigations:
24-h urinary metanephrine5.4 umol (<2)
24-h urinary normetanephrine15.2 umol (<3) What substance is most likely to cause assay interference in the measurement of urinary metanephrines?

A) alcohol
B) caffeine
C) amitriptyline
D) nicotine
E) paracetamol

Solutions: