MRCPUK SEND

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

1. A 54-year-old man was referred to the diabetes foot clinic with a plantar foot ulcer of 3 months' duration under the right first metatarsal head. He had a 10-year history of type 2 diabetes mellitus. He lived alone and had to do his own shopping and cleaning.
On examination, the ulcer was 3 ? 2 cm in area, 4 mm in depth, and had a clean granulating base. He had strong palpable pedal pulses and sensory neuropathy in both feet.
What is the most effective intervention to heal this ulcer?

A) removable pressure-relieving boot
B) ambulatory vacuum-assisted pump therapy
C) total contact casting
D) long-term oral antibiotics
E) Manuka honey-impregnated wound dressing

2. A 64-year-old man, who was undergoing investigation for altered bowel habit, was referred to the endocrine clinic after a CT scan of abdomen had shown a 4-cm mass in his left adrenal gland. He had a history of hypertension and type 2 diabetes mellitus.
Investigations:
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol350 nmol/L (<50)
24-h urinary free cortisol400 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)2.0 pmol/L (3.3-15.4)
He underwent laparoscopic removal of his left adrenal gland.
How should his endocrine condition be managed following surgery?

A) immediate postoperative tetracosactide (Synacthen@) test and, if abnormal, start hydrocortisone
B) introduce hydrocortisone and fludrocortisone postoperatively according to blood pressure and electrolytes
C) start hydrocortisone perioperatively and continue until tetracosactide (Synacthen@) test in 6 weeks
D) 24-h urinary cortisol 6 weeks postoperatively and start hydrocortisone if abnormally low
E) tetracosactide (Synacthen@) test 6 weeks postoperatively and start hydrocortisone if abnormal

3. A 39-year-old woman with Graves' disease was considered suitable for treatment with radioiodine. She was keen that her thyrotoxicosis should not recur. The plan was to request a 600 MBq dose.
What is the probability of resolution of thyrotoxicosis with this dose?

A) 20%
B) 40%
C) 80%
D) >95%
E) 60%

4. A 78-year-old man presented with confusion, lethargy and thirst. He had hypertension treated with lisinopril 20 mg daily.
On examination, he was dehydrated. His pulse was 110 beats per minute and his blood pressure was 84/40 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium155 mmol/L (137-144) serum potassium5.2 mmol/L (3.5-4.9) serum bicarbonate17 mmol/L (20-28) serum urea40.0 mmol/L (2.5-7.0)
serum creatinine358 umol/L (60-110) random plasma glucose78.0 mmol/L He was treated with sodium chloride 0.9%. After 8 hours' treatment, his urine output was
10 mL/h and his blood pressure was 121/50 mmHg. Investigations (after 8 hours' treatment): serum sodium151 mmol/L (137-144)
serum potassium4.9 mmol/L (3.5-4.9) serum bicarbonate18 mmol/L (20-28) serum urea39.0 mmol/L (2.5-7.0) serum creatinine347 umol/L (60-110)
random plasma glucose48.0 mmol/L
What is the most appropriate next step in management?

A) sodium chloride 0.18% and glucose 4%
B) sodium chloride 0.18% and glucose 5%
C) sodium chloride 0.45%
D) sodium chloride 0.9%
E) compound lactate solution (Hartmann's solution)

5. A 16-year-old girl presented with primary amenorrhoea. In early childhood she had undergone an inguinal herniorrhaphy. She had no other medical history of note. There was a family history of infertility affecting a maternal aunt.
On examination, she had adult breast development but no pubic or axillary hair. Examination was otherwise normal.
What test is most likely to aid diagnosis?

A) ovarian antibody titres
B) blood karyotype
C) MR scan of pituitary and olfactory bulbs
D) plasma gonadotropins
E) ultrasound scan of pelvis

Solutions: