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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

A 72-year-old man with a 12-year history of type 2 diabetes mellitus was found to have carcinoma of the bladder. He was taking metformin; however, this was stopped because of his deteriorating renal function.
On examination, his weight was 95 kg and his body mass index was 32 kg/m2 (18-25).
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine175 umol/L (60-110)
estimated glomerular filtration rate (MDRD)27 mL/min/1.73 m2 (>60)
haemoglobin A1c64 mmol/mol (20-42)
What is the most appropriate addition to his medication?

A. gliclazide
B. dapagliflozin
C. pioglitazone
D. sitagliptin
E. liraglutide

Question 2

A 25-year-old woman with type 1 diabetes mellitus was admitted to hospital with a 12-hour
history of nausea and lethargy.
On examination, her temperature was 37.5C, she was dehydrated and her Glasgow coma
score was 14. Urinalysis showed glucose 2+, ketones 3+, protein negative.
Investigations:
white cell count12.0 ? 109/L (4.0-11.0)
neutrophil count8.0 ? 109/L (1.5-7.0)
random plasma glucose22.0 mmol/L
arterial blood gases, breathing air:
pH7.20 (7.35-7.45)
serum C-reactive protein12 mg/L (<10)
She was treated with intravenous sodium chloride 0.9% and fixed-rate intravenous insulin
infusion, and initially improved. Twelve hours into her admission, she complained of a
headache.
On examination, her temperature was 37.3C and her Glasgow coma score was 15. Her
pulse was 85 beats per minute and her blood pressure was 110/70 mmHg. There was no
neck stiffness, papilloedema or focal neurological signs.
What is the most likely cause for her headache?

A. bacterial meningitis
B. sagittal sinus thrombosis
C. viral encephalitis
D. tension headache
E. cerebral oedema

Question 3

A 50-year-old Asian woman with an 18-year history of type 2 diabetes mellitus complained of discomfort and mild swelling in her left foot after tripping on a pavement. She was being treated with metformin, gliclazide and pioglitazone.
On examination, her foot was warm and slightly oedematous over the dorsum but not discoloured. She was afebrile and the foot pulses were bounding. Tendon reflexes in the legs were absent and vibration perception diminished. Urinalysis showed protein 2+, glucose 1+.
Investigations:
white cell count5.2 ? 109/L (4.0-11.0)
serum creatinine140 umol/L (60-110)
haemoglobin A1c63 mmol/mol (20-42)
X-ray of left footnormal bone architecture; some calcification of the arteries
isotope bone scanincreased isotope uptake in the mid-foot only
What is the most effective next step in management?

A. below-knee removable walking boot
B. celecoxib
C. co-amoxiclav
D. alendronic acid
E. immobilisation in a cast

Question 4

A 52-year-old man, with a 20-year history of type 2 diabetes mellitus, had been treated with metformin and, for the previous 4 years, biphasic insulin aspart twice daily. He had recently started a new job that required him to drive a 7.5-tonne vehicle.
If he were to apply for a UK Class C1 driving licence, who should complete the application form with him?

A. consultant physician specialising in diabetes
B. occupational health physician
C. solicitor
D. diabetes specialist nurse in secondary care
E. general practitioner

Question 5

A 25-year-old woman presented at 28 weeks' gestation after a screening 75-g oral glucose tolerance test, which had shown a fasting plasma glucose of 5.6 mmol/L (3.0-6.0) and a 2h plasma glucose of 9.8 mmol/L (<7.8). She had a family history of type 2 diabetes mellitus and a pre-pregnancy body mass index of 36 kg/m2 (18-25). Home blood glucose monitoring had shown persistently raised blood glucose despite dietary modification. She refused insulin because of needle phobia and was concerned about drug exposure to her unborn child.
The use of what hypoglycaemic therapy is acceptable in this situation?

A. gliclazide
B. glibenclamide
C. exenatide
D. pioglitazone
E. sitagliptin

Solutions: