MRCPUK SEND : Endocrinology and Diabetes (Specialty Certificate Examination)

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MRCPUK SEND Exam Syllabus Topics:

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

1. An 18-year-old man presented to the thyroid clinic complaining of a lump in his neck that had been present for 9 weeks. It was not painful. At the age of 12, he had developed acute lymphoblastic leukaemia and had undergone a bone marrow transplant preceded by total body irradiation and cyclophosphamide.
On examination, he was euthyroid. There was a 1.5-cm firm mass on the left side of the neck, which moved when he swallowed.
Investigations:
serum thyroid-stimulating hormone1.9 mU/L (0.4-5.0)
serum free T416.8 pmol/L (10.0-22.0)
What is the most appropriate initial course of action?

A) technetium-99m scintigraphy scan of thyroid
B) ultrasound-guided fine-needle aspiration of the nodule
C) surgical referral for hemithyroidectomy
D) CT scan of neck and thorax
E) FDG-PET-CT scan

2. A 54-year-old man on the neurosurgery unit developed hyponatraemia 3 days after presenting with a significant head injury. His Glasgow coma score (GCS) had been 6 on admission.
On examination, his GCS was 12. His blood pressure was 124/84 mmHg. There was no
oedema.
Investigations:
serum sodium118 mmol/L (137-144)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine72 umol/L (60-110)
random serum cortisol (08.00 h on day of review)480 nmol/L
serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0)
random urinary sodium60 mmol/L
What is the most appropriate interpretation of these data?

A) intravascular volume depletion
B) the diagnosis would be helped by measurement of plasma vasopressin concentration
C) they are consistent with syndrome of inappropriate antidiuresis
D) a short tetracosactide (Synacthen@) test (250 micrograms) is required to exclude secondary hypoadrenalism
E) the urinary sodium concentration is diagnostic of cerebral salt wasting

3. A 33-year-old woman, who was 9 weeks into her first pregnancy, was admitted with prolonged vomiting and secondary dehydration. She had lost 6 kg in weight since becoming pregnant. There was a strong family history of thyroid disease: two sisters were hypothyroid and one brother had required radioactive iodine for Graves' disease.
On examination, she had a smooth, small goitre. Her pulse was 94 beats per minute and her blood pressure was 104/42 mmHg. There was a tremor of the outstretched hands. Urinalysis was normal.
Investigations:
serum sodium143 mmol/L (137-144) serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine105 umol/L (60-110)
serum thyroid-stimulating hormone (TSH)<0.01 mU/L (0.4-5.0)
serum free T424.0 pmol/L (10.0-22.0)
serum free T311.0 pmol/L (3.0-7.0)
A TSH receptor antibody concentration was awaited.
In addition to rehydration, what is the most appropriate next step in the management of her abnormal thyroid function?

A) observation
B) propylthiouracil
C) labetalol
D) propranolol
E) carbimazole

4. A 17-year-old boy with type 1 diabetes mellitus was admitted with diabetic ketoacidosis
precipitated by a recent viral illness.
Investigations on admission:
random plasma glucose15.0 mmol/L
arterial blood gases, breathing air:
pH7.07 (7.35-7.45)
H+85 nmol/L (35-45)
Investigations after initial treatment with fluids, insulin and potassium 7 h after admission:
random plasma glucose4.0 mmol/L
serum bicarbonate10 mmol/L (20-28)
At this stage, he was being given infusions of insulin (1 U/h) and glucose 5% (100 mL/h).
What is the most appropriate next step in management?

A) continue insulin infusion and change glucose to a higher concentration
B) give intravenous sodium bicarbonate
C) continue current regimen
D) continue current regimen but encourage oral carbohydrate intake
E) stop insulin infusion if glucose falls any further, then repeat plasma glucose in 15 min

5. A 20-year-old man presented with a 6-month history of lethargy and weakness. His brother had been found to have adrenal failure at the age of 18. He had two sisters who were well and there was no other family history of endocrine autoimmune disease.
On examination, his blood pressure was 100/60 mmHg.
Investigations:
serum sodium136 mmol/L (137-144)
serum potassium4.8 mmol/L (3.5-4.9)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol100 nmol/L
serum cortisol (30 min after tetracosactide)250 nmol/L (>550)
anti-adrenal antibodiesnegative
What is the most important diagnosis to consider?

A) isolated adrenocorticotropic hormone deficiency
B) autoimmune hypoadrenalism
C) familial glucocorticoid resistance
D) tuberculosis
E) adrenoleucodystrophy

Solutions: