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MRCPUK SEND Exam Syllabus Topics:

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

1. A 35-year-old woman was referred with a left lower thyroid lesion. She was asymptomatic.
Examination confirmed the presence of a 2 ? 3-cm, firm, mobile, non-tender mass.
Investigations:
ultrasound-guided fine-needle aspiration biopsyThy 5
How is Thy 5 defined?

A) abnormal, suspicious (but not diagnostic of) malignancy
B) follicular lesions
C) abnormal, diagnostic of malignancy
D) non-neoplastic (consistent with nodular goitre or thyroiditis)
E) non-diagnostic or inadequate

2. A 26-year-old woman presented acutely with abdominal pain. On examination, her blood pressure was 124/72 mmHg.
Investigations:
24-h urinary dopamine10 000 nmol (<3100)
24-h urinary adrenaline43 nmol (<144)
24-h urinary noradrenaline146 nmol (<570)
CT scan of abdomen3-cm left para-aortic mass
She underwent surgical exploration and removal of the lesion, which proved to be a paraganglioma. One local lymph node, removed at the same time, was also positive for the presence of tumour.
What is the most likely underlying genetic syndrome?

A) neurofibromatosis type 1 mutation
B) von Hippel-Lindau syndrome
C) multiple endocrine neoplasia type 2a
D) Gardner's syndrome
E) succinate dehydrogenase type B mutation

3. A 55-year-old dental nurse was referred for bone densitometry after sustaining a non-displaced fracture of the femur after falling down a step. She had experienced no other fractures. Her only medical problem was long-standing anaemia of unknown cause. The only family history was of persistent dental abscesses affecting her father. She had three children who were well. She was taking no medication.
Examination was normal.
Investigations:
haemoglobin102 g/L (115-165)
MCV85 fL (80-96)
white cell count6.0 ? 109/L (4.0-11.0)
platelet count245 ? 109/L (150-400)
erythrocyte sedimentation rate25 mm/1st h (<30)
serum creatinine85 umol/L (60-110)
serum corrected calcium2.40 mmol/L (2.20-2.60)
serum alkaline phosphatase56 U/L (45-105)
DXA scan spine (L2-L4)T score +5.8
DXA scan total hipT score +5.4
What is the most likely diagnosis?

A) high bone mass phenotype
B) Paget's disease
C) osteopetrosis
D) fluorosis
E) myelodysplasia

4. A 26-year-old man with type 1 diabetes mellitus attended a carbohydrate-counting course to facilitate tighter glucose control. He estimated that his carbohydrate ratio was 1:10 and 1 unit correction dose reduced his glucose by 3.0 mmol/L.
He planned to eat a meal containing 50 g of carbohydrate. His pre-meal glucose was 16.0 mmol/L with a target blood glucose of 7.0 mmol/L.
What is the correct dose of bolus insulin (units) that he should administer?

A) 2
B) 4
C) 8
D) 10
E) 6

5. A 69-year-old man with type 2 diabetes mellitus presented with a 3-day history of an ulcer on his right second toe.
On examination, the toe was red, swollen and enlarged, and looked like a 'sausage digit'. The ulcer appeared superficial.
Investigations:
X-ray of right second toeno sign of osteomyelitis
Cultures from the debrided wound bed were taken and the results were awaited.
What is the most appropriate type of antibiotic regimen to start empirically before the culture results are available?

A) narrow spectrum for 6 weeks
B) no antibiotic
C) broad spectrum for 6 weeks
D) narrow spectrum for 10 days
E) broad spectrum for 10 days

Solutions: