MRCPUK SEND Value Pack (Frequently Bought Together)

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MRCPUK SEND Exam Syllabus Topics:

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

1. A 41-year-old man presented to his general practitioner with symptoms of palpitations, sweating and anxiety. His blood pressure was 160/102 mmHg. He was advised to take propranolol 40 mg twice daily but was admitted to hospital later that week with an episode of pulmonary oedema.
On examination at the time of admission, he was noted to be pale and sweating and he had a blood pressure of 210/124 mmHg. A phaeochromocytoma was suspected.
What is the most likely cause of the cardiovascular deterioration following administration of propranolol?

A) inhibition of catechol-O-methyltransferase by propranolol leading to an increase in circulating noradrenaline
B) ?1-adrenoceptor blockade leading to acute left ventricular dysfunction
C) propranolol acting as an agonist at ?1-adrenoceptors
D) inadequate ?-adrenoceptor blockade because of the short half-life of the drug
E) loss of ?2-adrenoceptor-mediated vasodilatation

2. A 32-year-old woman presented to the outpatient clinic with a 1-year history of amenorrhoea that began after stopping her oral contraceptive pill. She had previously had two successful pregnancies and was otherwise well.
Examination was normal and no visual field defect was present on testing to confrontation.
Investigations:
serum sodium138 mmol/L (137-144) serum potassium3.8 mmol/L (3.5-4.9) plasma follicle-stimulating hormone2.0 U/L (2.5-10.0) plasma luteinising hormone2.0 U/L (2.5-10.0) serum prolactin1050 mU/L (<360)
MR scan of pituitarysee image

What is the most appropriate treatment?

A) pituitary surgery
B) cabergoline
C) octreotide
D) stereotactic pituitary radiosurgery
E) bromocriptine

3. A 17-year-old girl presented with primary amenorrhoea. She had grown and developed normally. There was no history of galactorrhoea or hirsutism.
On examination, her height was 1.69 m, her weight was 68.3 kg, and her body mass index was 23.9 kg/m2 (18-25). She had stage 5 breast development and stage 5 pubic hair. Her visual fields were full to confrontation.
Investigations:
serum cortisol (09.00 h)416 nmol/L (200-700) serum oestradiol51 pmol/L (200-400)
serum follicle-stimulating hormone0.8 U/L (2.5-10.0) serum luteinising hormone1.2 U/L (2.5-10.0) serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0) serum free T415.6 pmol/L (10.0-22.0)
What is the most appropriate next investigation?

A) karyotyping
B) short tetracosactide (Synacthen@) test
C) luteinising hormone-releasing hormone test
D) serum prolactin
E) serum insulin-like growth factor 1

4. A 64-year-old man was reviewed in the diabetes clinic. He had a history of type 2 diabetes mellitus treated for 12 years. He had sustained a previous episode of acute kidney injury believed to be secondary to renal artery stenosis and exposure to an ACE inhibitor. He was being treated with metformin 500 mg three times daily and gliclazide 80 mg twice daily.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine123 umol/L (60-110)
estimated glomerular filtration rate (MDRD)51 mL/min/1.73 m2 (>60)
haemoglobin A1c75 mmol/mol (20-42)
He required a third drug that would not require dose adjustment if renal function were to decline in the future.
What additional medication is most appropriate?

A) saxagliptin
B) linagliptin
C) alogliptin
D) sitagliptin
E) vildagliptin

5. A 34-year-old woman with Addison's disease reported four adrenal crises over the preceding 6 months, requiring hospital admission and intravenous administration of hydrocortisone. At outpatient follow-up, she was taking hydrocortisone 15 mg in the morning and 10 mg at midday, and fludrocortisone 50 micrograms daily.
What is the most important next step in management to prevent further crises?

A) change to sustained-release hydrocortisone
B) measure plasma renin
C) measure post-dose 09.00 h cortisol
D) increase dosage of hydrocortisone
E) measure plasma adrenocorticotropic hormone

Solutions: