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MRCPUK SEND Exam Syllabus Topics:

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

1. A 58-year-old man presented with tiredness and breathlessness. He had been treated for type 2 diabetes mellitus and hypertension for the past 10 years. He was free of complications. His current medication included ramipril 10 mg daily, rosuvastatin 10 mg daily, metformin 500 mg three times daily, dapagliflozin 10 mg once daily and exenatide 10 micrograms twice daily.
On examination, his body mass index was 36 kg/m2 (18-25).
Investigations:
haemoglobin93 g/L (130-180)
MCV110 fL (80-96)
white cell count3.6 ? 109/L (4.0-11.0)
platelet count140 ? 109/L (150-400)
reticulocyte count0.5% (0.5-2.4)
serum ferritin250 ug/L (15-300)
serum vitamin B1240 ng/L (160-760)
serum folate3.0 ug/L (2.0-11.0)
Which medication is most likely to be contributing to his anaemia?

A) rosuvastatin
B) exenatide
C) ramipril
D) dapagliflozin
E) metformin

2. A 33-year-old woman was seen for diabetes review 2 months after her first pregnancy. Diabetes mellitus had been diagnosed at 18 weeks' gestation. She had experienced no symptoms; routine urinalysis had shown glucose 4+, with no ketones, and her fasting blood glucose concentration was 6.2 mmol/L (3.0-6.0), rising to 13.5 mmol/L (<7.8) in a 75-g oral glucose tolerance test. She had been treated with insulin during the pregnancy, and stopped after delivery. Her mother and maternal aunt had been treated for type 2 diabetes mellitus, and a maternal uncle for type 1 diabetes. Her body mass index was 23.7 kg/m2 (18-25).
Without insulin she remained well, with no osmotic symptoms, no weight loss and no ketosis.
Investigations:
fasting plasma glucose8.4 mmol/L (3.0-6.0)
haemoglobin A1c68 mmol/mol (20-42)
oral glucose tolerance test (75 g):
fasting plasma glucose7.9 mmol/L (3.0-6.0)
2-h plasma glucose13.8 mmol/L (<7.8)
serum insulin72 pmol/L (<186)
serum C-peptide945 pmol/L (180-360)
A trial of therapy with gliclazide 40 mg once daily led to a significant improvement in her blood glucose.
What is the most likely cause of her diabetes?

A) type 1 diabetes mellitus
B) type 2 diabetes mellitus
C) maturity-onset diabetes of the young caused by glucokinase mutation
D) maturity-onset diabetes of the young caused by HNF-1? mutation
E) latent autoimmune diabetes in adulthood

3. A 43-year-old man was in an ENT ward, having recently undergone removal of a carotid body tumour.
Five years previously, he had undergone a similar procedure in another hospital. He also recalled that his brother had undergone surgery for a similar condition, and that his father, who had since died, might also have had neck surgery.
The ENT surgeons were concerned that there might be an underlying genetic diagnosis.
What is the most likely diagnosis?

A) von Hippel-Lindau disease
B) multiple endocrine neoplasia type 2
C) succinate dehydrogenase A deficiency
D) neurofibromatosis type 1
E) succinate dehydrogenase D deficiency

4. A 17-year-old girl with Turner's syndrome attended the clinic for review. She had been treated with growth hormone therapy for the previous 7 years, and had now reached her final adult height.
What is the most appropriate next step in management?

A) assess her bone density by DXA scan and continue growth hormone if bone mineral density is less than mean for age
B) stop growth hormone therapy
C) continue growth hormone until 25 years old then reassess
D) withdraw growth hormone therapy for 3 months and evaluate growth hormone secretion
E) start to reduce growth hormone therapy with a view to discontinuing in 2 years' time

5. A 19-year-old man was seen in the diabetes clinic. He had lost 2 kg in weight since the diagnosis of diabetes mellitus 18 months previously. At presentation, his body mass index was 33 kg/m2 (18-25), his random plasma glucose was 18.0 mmol/L and his haemoglobin A1c was 56 mmol/mol (20-42). He was taking gliclazide, and metformin had been added later. His father and grandfather had developed diabetes mellitus during their twenties.
Investigations:
haemoglobin A1c56 mmol/mol (20-42)
serum C-peptide301 pmol/L (180-360)
anti-glutamic acid decarboxylase (GAD)
antibodiesnegative
What is the most likely diagnosis?

A) type 1 diabetes mellitus
B) type 2 diabetes mellitus
C) maturity-onset diabetes of the young
D) latent-onset diabetes of autoimmunity
E) chronic pancreatitis

Solutions: