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MRCPUK SEND Exam Syllabus Topics:

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

1. A 32-year-old woman, with a 22-year history of type 1 diabetes mellitus, was seen in a pre-pregnancy diabetes clinic. She was a primigravida.
On examination, she had early background retinopathy, her blood pressure was 128/68 mmHg, and her body mass index was 29.7 kg/m2 (18-25).
Investigations:
haemoglobin A1c56 mmol/mol (20-42)
urinary albumin:creatinine ratio1.2 mg/mmol (<3.5)
Over the years her haemoglobin A1c concentration had varied between 58 and 69 mmol/mol. She had impaired awareness of hypoglycaemia and experienced approximately two severe hypoglycaemic events per year. She was worried about the risk of severe congenital malformations in her baby.
To what extent will the average risk of severe congenital malformation be increased in infants born to this mother with pregestational diabetes?

A) eight-fold
B) four-fold
C) ten-fold
D) two-fold
E) six-fold

2. A 42-year-old motor mechanic was referred to the dermatologist with small cauliflower-like deposits on the points of his elbows. He was generally well, but on systemic enquiry, he described intermittent claudication. He had previously been hypertensive, and was taking thyroxine for primary hypothyroidism.
On examination, he was moderately obese. He had xanthelasmata on the upper eyelids of both eyes and tuberoeruptive xanthomata on both elbows, both knees and the nape of the neck.
Investigations:
serum alanine aminotransferase78 U/L (5-35)
fasting plasma glucose7.8 mmol/L (3.0-6.0)
serum urate0.48 mmol/L (0.23-0.46)
serum cholesterol13.4 mmol/L (<5.2)
serum LDL cholesterolnot measurable
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides9.32 mmol/L (0.45-1.69)
apolipoprotein E genotypehomozygous for apolipoprotein E2
What is the most likely diagnosis?

A) type III hyperlipidaemia (dysbetalipoproteinaemia)
B) abetalipoproteinaemia
C) familial combined hyperlipidaemia
D) heterozygous familial hypercholesterolaemia
E) lipoprotein lipase deficiency

3. A 17-year-old girl was referred to the outpatient clinic with irritability, weight loss and difficulty sleeping. At the age of 4, she had presented with rapid growth, breast development and vaginal bleeding. The results of a gonadotropin-releasing hormone (GnRH) stimulation test performed at that time are given below.
serum oestradiolplasma FSHplasma LH
(200-400 pmol/L)(2.5-10.0 U/L)(2.5-10.0 U/L)
0 min365<0.7<0.5
30 min-<0.7<0.5
60 min-<0.7<0.5
She had been treated with GnRH analogue until the age of 11 and puberty had then progressed normally.
On examination, she was found to be tremulous, tachycardic and hyper-reflexic. Several large, irregular cafe-au-lait spots were found.
Investigations:
serum thyroid-stimulating hormone<0.05 mU/L (0.4-5.0)
serum free T436.0 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A) McCune-Albright syndrome
B) neurofibromatosis type 1
C) Cowden's syndrome
D) multiple endocrine neoplasia type 2
E) Carney's complex

4. Carbimazole is routinely used in the management of thyroid disease.
What does carbimazole inhibit?

A) thyroglobulin synthesis
B) thyroid peroxidase
C) presentation of thyroid antigens to autoreactive T cells
D) sodium/iodide symporter
E) deiodinase type 1

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

Solutions: