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MRCPUK SEND Exam Syllabus Topics:

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

1. A 73-year-old man had been attending the diabetes clinic for 6 weeks with an ulcer on his right second metatarsal head. He had been receiving regular podiatry and offloading.
What new feature in the appearance of his foot is most likely to suggest the need to start antibiotics?

A) tracking sinus
B) ulcer probing to bone
C) skin redness around ulcer
D) increase in ulcer size
E) pain around ulcer

2. A 15-year-old boy with a 10-year history of type 1 diabetes mellitus was referred to the adolescent diabetes clinic from the paediatric clinic. Diabetes control had always been satisfactory and his recent haemoglobin A1c concentration was 67 mmol/mol (20-42). He felt generally well, although on a growth chart his weight had fallen steadily from the 50th centile 18 months previously to the 10th centile, and his height had fallen from the 50th centile to the 25th centile. He had stage 4 genital development and stage 4 pubic hair, and testicular volume was 15 mL.
What is the most appropriate investigation?

A) serum testosterone
B) thyroid-stimulating hormone and free thyroxine
C) short tetracosactide (Synacthen@) test
D) anti-tissue transglutaminase antibodies
E) insulin-like growth factor 1

3. 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) 6
B) 2
C) 10
D) 4
E) 8

4. A 24-year-old woman was referred with an 18-month history of worsening hirsutism, primarily on her face, but also new hair growth on her chest. She was shaving weekly. She had always been overweight, but had recently gained 5 kg and her body mass index was 31 kg/m2 (18-25). Her periods were regular.
What is the most relevant next investigation?

A) plasma thyroid-stimulating hormone
B) serum 17-hydroxyprogesterone
C) serum testosterone
D) serum dehydroepiandrosterone
E) overnight dexamethasone suppression test (after 1 mg dexamethasone)

5. A 28-year-old Asian woman was seen in the joint diabetes-antenatal clinic at 16 weeks' gestation. She gave a history of gestational diabetes during her previous pregnancy. She had a strong family history of diabetes mellitus. She was fit and well, and had no symptoms other than slight early morning sickness.
According to NICE guidance (NG3, February 2015) for management of pregnancy, what is the most appropriate way to screen for gestational diabetes in this woman?

A) 2-h postprandial plasma glucose
B) oral glucose tolerance test as soon as possible
C) fasting plasma glucose
D) oral glucose tolerance test at 24-28 weeks' gestation
E) haemoglobin A1c

Solutions: