MRCPUK SEND : Endocrinology and Diabetes (Specialty Certificate Examination)

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

1. An 18-year-old man presented with delayed puberty.
On examination, he had a high arched palate. His sense of smell was intact, and he had a
family history of pubertal delay. Kallman's syndrome was suspected.
Investigations:
serum testosterone0.3 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.0 U/L (1.0-10.0)
bone age15 years
What further clinical finding would most strongly support the diagnosis of Kallman's
syndrome?

A) bimanual synkinesia (mirror movements)
B) eunuchoid habitus
C) testes 6 mL bilaterally
D) night blindness
E) short stature

2. A 27-year-old woman with type 1 diabetes mellitus was invited to attend a structured education (e.g. DAFNE) coursE.
Which quality of life domain is most affected when a person is found to have type 1 diabetes mellitus?

A) family life
B) enjoyment of leisure activities
C) freedom to eat as one wishes
D) sex life
E) working life and work-related opportunities

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

4. A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty.
Clinical examination showed central obesity, a body mass index of 32 kg/m2 (18-25) and a blood pressure of 140/90 mmHg.
The following results were obtained within 1 week of her last menstrual period.
Investigations:
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol30 nmol/L (<50)
serum dehydroepiandrosterone sulphate12 umol/L (3-12)
serum androstenedione10.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone38 nmol/L (1-10)
serum oestradiol200 pmol/L (200-400)
serum testosterone3.5 nmol/L (0.5-3.0)
serum sex hormone binding globulin30 nmol/L (40-137)
plasma follicle-stimulating hormone4.0 U/L (2.5-10.0)
plasma luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?

A) late-onset congenital adrenal hyperplasia
B) polycystic ovary syndrome
C) ovarian androgen-secreting tumour
D) Cushing's syndrome
E) adrenal androgen-secreting tumour

5. A 58-year-old woman was referred with an incidental finding of mild hypercalcaemia. She had no relevant symptoms or significant medical history. She was taking no medication.
Investigations:
serum creatinine101 umol/L (60-110) serum corrected calcium2.71 mmol/L (2.20-2.60) serum alkaline phosphatase78 U/L (45-105)
plasma parathyroid hormone6.8 pmol/L (0.9-5.4) serum 25-OH-cholecalciferol76 nmol/L (45-90)
What is the most appropriate next investigation?

A) calcium:creatinine clearance ratio
B) bone mineral density scan
C) parathyroid isotope scan
D) calcium-sensing receptor gene mutation analysis
E) ultrasound scan of neck

Solutions: