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MRCPUK SEND Exam Syllabus Topics:

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

1. A 39-year-old man was admitted with severe burns.
On examination, he was noted to be persistently tachycardic.
Investigations:
serum thyroid-stimulating hormone0.2 mU/L (0.4-5.0)
serum free T410.0 pmol/L (10.0-22.0)
serum free T32.5 pmol/L (3.0-7.0)
What is the most appropriate next step in investigation of his thyroid status?

A) thyroid autoantibodies
B) radionuclide thyroid uptake scan
C) reverse tri-iodothyronine
D) thyrotrophin-releasing hormone test
E) repeat blood tests after recovery

2. A 75-year-old woman presented with a 4-week history of lethargy. Her medical history was unremarkable and she took no medication.
On examination, her blood pressure was 140/70 mmHg lying. She was euvolaemic.
Investigations:
serum sodium120 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine75 umol/L (60-110)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol450 nmol/L (200-700)
serum cortisol (30 min after tetracosactide)600 nmol/L (>550)
serum thyroid-stimulating hormone2.5 mU/L (0.4-5.0)
serum free T416.9 pmol/L (10.0-22.0)
urinary sodium70 mmol/L
What is the most appropriate initial management?

A) fluid restriction
B) demeclocycline
C) tolvaptan
D) intravenous sodium chloride 0.9%
E) hydrocortisone

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

4. A 27-year-old woman was referred with abnormal thyroid function tests. She was well and reported no symptoms of thyroid disease apart from occasional palpitations. Her sister had been investigated for a thyroid problem recently. The patient was taking no medication.
Examination was normal.
Investigations:
serum thyroid-stimulating hormone7.6 mU/L (0.4-5.0) serum free T4 28.5 pmol/L (10.0-22.0)
serum free T3 13.6 pmol/L (3.0-7.0)
Her results were confirmed and no evidence of assay interference was reported by the clinical chemist, who indicated that similar thyroid function tests had been obtained 5 years previously.
MR scan of pituitarynormal
What is the most appropriate next investigation?

A) sequencing the ?-subunit of the thyroid hormone receptor gene
B) thyrotropin-releasing hormone test
C) iodine uptake scan
D) sequencing the thyroid-stimulating hormone receptor gene
E) serum thyroglobulin

5. A 64-year-old man attended the diabetes clinic for annual review. He complained of very recent tingling in his feet. A monofilament was used to screen for the presence of chronic sensorimotor diabetic peripheral neuropathy.
What force should a monofilament deliver?

A) 2 g
B) 5 g
C) 10 g
D) 1 g
E) 20 g

Solutions: