MRCPUK SEND - SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Exam
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Total 200 questions
Question #11 (Topic: )
A 25-year-old man presented with a 2-month history of thirst and polyuria. He had minimal
weight loss and his body mass index was 26 kg/m2 (1825). He had had sensorineural
deafness since childhood. There was a very strong family history of sensorineural deafness
and type 2 diabetes mellitus.
Urinalysis showed no ketones.
Investigations:
random plasma glucose18.0 mmol/L
What is the most appropriate next step in management?
weight loss and his body mass index was 26 kg/m2 (1825). He had had sensorineural
deafness since childhood. There was a very strong family history of sensorineural deafness
and type 2 diabetes mellitus.
Urinalysis showed no ketones.
Investigations:
random plasma glucose18.0 mmol/L
What is the most appropriate next step in management?
A. genetic testing for maturity-onset diabetes of the young
B. measurement of glutamic acid decarboxylase antibodies
C. test for HFE genotype
D. test for mitochondrial diabetes
E. water deprivation test to assess posterior pituitary function
Answer: D
Question #12 (Topic: )
A 34-year-old woman with a 21-year history of type 1 diabetes mellitus had started
treatment with subcutaneous insulin pump therapy 18 months previously. Her haemoglobin
A1c before starting pump therapy was 77 mmol/mol (2042) and she had experienced
severe hypoglycaemic events without warning symptoms over the previous 4 years.
At review in clinic, she reported continuing episodes of severe hypoglycaemia without
warning symptoms despite regular monitoring and advice from her insulin pump nurse
specialist.
On examination, her blood pressure was 134/80 mmHg and fundoscopy revealed
moderate background diabetic retinopathy. Examination of the feet revealed strong,
palpable pedal pulses and early evidence of sensory neuropathy.
Investigations:
estimated glomerular filtration rate (MDRD)24 mL/min/1.73 m2 (>60)
haemoglobin A1c56 mmol/mol (2042)
24-h urinary total protein2.3 g (<0.2)
What is the most appropriate next step in management?
treatment with subcutaneous insulin pump therapy 18 months previously. Her haemoglobin
A1c before starting pump therapy was 77 mmol/mol (2042) and she had experienced
severe hypoglycaemic events without warning symptoms over the previous 4 years.
At review in clinic, she reported continuing episodes of severe hypoglycaemia without
warning symptoms despite regular monitoring and advice from her insulin pump nurse
specialist.
On examination, her blood pressure was 134/80 mmHg and fundoscopy revealed
moderate background diabetic retinopathy. Examination of the feet revealed strong,
palpable pedal pulses and early evidence of sensory neuropathy.
Investigations:
estimated glomerular filtration rate (MDRD)24 mL/min/1.73 m2 (>60)
haemoglobin A1c56 mmol/mol (2042)
24-h urinary total protein2.3 g (<0.2)
What is the most appropriate next step in management?
A. change to intensified subcutaneous insulin injections
B. refer for allogeneic pancreas transplantation
C. refer for allogeneic pancreatic islet cell transplantation
D. refer for combined pancreas and kidney transplantation
E. refer for continuous glucose monitoring
Answer: D
Question #13 (Topic: )
A 34-year-old woman presented with palpitations, heat intolerance and a slight tremor. She
was 9 weeks into her first pregnancy. She had not had any morning sickness.
On examination, her pulse was 100 beats per minute. She had a small uniform goitre but
no tremor and no eye signs.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.45.0)
serum free T442.0 pmol/L (10.022.0)
serum free T315.0 pmol/L (3.07.0)
anti-thyroid-stimulating hormone receptor
antibodies14 U/L (<7)
The decision was taken to treat her Graves disease with propylthiouracil (PTU) rather than
carbimazole.
What is the reason for this decision?
was 9 weeks into her first pregnancy. She had not had any morning sickness.
On examination, her pulse was 100 beats per minute. She had a small uniform goitre but
no tremor and no eye signs.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.45.0)
serum free T442.0 pmol/L (10.022.0)
serum free T315.0 pmol/L (3.07.0)
anti-thyroid-stimulating hormone receptor
antibodies14 U/L (<7)
The decision was taken to treat her Graves disease with propylthiouracil (PTU) rather than
carbimazole.
What is the reason for this decision?
A. concordance with PTU is greater
B. PTU does not cross the placenta
C. PTU is less associated with agranulocytosis
D. PTU is less associated with aplasia cutis
E. PTU is less associated with hepatitis
Answer: D
Question #14 (Topic: )
A 41-year-old man presented to his general practitioner with symptoms of palpitations,
sweating and anxiety. His blood pressure was 160/102 mmHg. He was advised to take
propranolol 40 mg twice daily but was admitted to hospital later that week with an episode
of pulmonary oedema.
On examination at the time of admission, he was noted to be pale and sweating and he
had a blood pressure of 210/124 mmHg. A phaeochromocytoma was suspected.
What is the most likely cause of the cardiovascular deterioration following administration of
propranolol?
sweating and anxiety. His blood pressure was 160/102 mmHg. He was advised to take
propranolol 40 mg twice daily but was admitted to hospital later that week with an episode
of pulmonary oedema.
On examination at the time of admission, he was noted to be pale and sweating and he
had a blood pressure of 210/124 mmHg. A phaeochromocytoma was suspected.
What is the most likely cause of the cardiovascular deterioration following administration of
propranolol?
A. ?1-adrenoceptor blockade leading to acute left ventricular dysfunction
B. inadequate ?-adrenoceptor blockade because of the short half-life of the drug
C. inhibition of catechol-O-methyltransferase by propranolol leading to an increase in circulating noradrenaline
D. loss of ?2-adrenoceptor-mediated vasodilatation
E. propranolol acting as an agonist at ?1-adrenoceptors
Answer: D
Question #15 (Topic: )
A 17-year-old girl was referred to the transition clinic. She was taking hydrocortisone 10 mg
twice daily and fludrocortisone 150 micrograms daily following a failed short tetracosactide
(Synacthen) test 5years previously. She had entered puberty at the age of 10 but had
never achieved adult breast development or menarche.
Investigations:
haemoglobin95 g/L (115165)
MCV124 fL (8096)
white cell count8.4 ? 109/L (4.011.0)
platelet count334 ? 109/L (150400)
serum sodium138 mmol/L (137144)
serum potassium4.4 mmol/L (3.54.9)
serum urea3.5 mmol/L (2.57.0)
serum corrected calcium1.80 mmol/L (2.202.60)
serum follicle-stimulating hormone67.9 U/L (2.510.0)
serum luteinising hormone56.4 U/L (2.510.0)
What is the most likely diagnosis?
twice daily and fludrocortisone 150 micrograms daily following a failed short tetracosactide
(Synacthen) test 5years previously. She had entered puberty at the age of 10 but had
never achieved adult breast development or menarche.
Investigations:
haemoglobin95 g/L (115165)
MCV124 fL (8096)
white cell count8.4 ? 109/L (4.011.0)
platelet count334 ? 109/L (150400)
serum sodium138 mmol/L (137144)
serum potassium4.4 mmol/L (3.54.9)
serum urea3.5 mmol/L (2.57.0)
serum corrected calcium1.80 mmol/L (2.202.60)
serum follicle-stimulating hormone67.9 U/L (2.510.0)
serum luteinising hormone56.4 U/L (2.510.0)
What is the most likely diagnosis?
A. atypical congenital adrenal hyperplasia
B. autoimmune polyglandular syndrome type 1
C. hypothalamic germinoma
D. pituitary stalk interruption syndrome
E. Turner’s syndrome
Answer: B
