MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) : SEND Exam

A 29-year-old woman presented with primary infertility, having had unprotected sexual intercourse for 15 months. Menarche had occurred at the age of 13.5 years. Her menstrual cycle was irregular, occurring every 20-60 days. There was no history of galactorrhoea. She denied abnormal hair growth.
On examination, her body mass index was 28.9 kg/m2 (18-25) and she had normal secondary sexual characteristics. Her visual fields were full to confrontation.
Investigations:
serum androstenedione12.8 nmol/L (0.6-8.8)
serum oestradiol205 pmol/L (200-400)
serum testosterone2.4 nmol/L (0.5-3.0)
serum sex hormone binding globulin23 nmol/L (40-137)
serum follicle-stimulating hormone4.3 U/L (2.5-10.0)
serum luteinising hormone8.5 U/L (2.5-10.0)
serum prolactin420 mU/L (<360)
hysterosalpingogrampatent fallopian tubes
partner's semen analysisnormal sperm count and motility
What is the most appropriate first-line intervention?

• A. human menopausal gonadotropins
• B. human chorionic gonadotropin
• C. metformin
• D. orlistat
• E. cabergoline

A 33-year-old man was referred to the diabetes clinic with an 8-month history of weight loss and polydipsia. Two months previously his general practitioner had found a high fasting plasma glucose concentration of 17.5 mmol/L (3.0-6.0) and a haemoglobin A1c of 116 mmol/mol (20-42). The patient was taking metformin 1 g twice daily. He reported in the diabetes clinic that his home capillary blood glucose concentrations persisted to be high, ranging between 15-24 mmol/L.
On examination, his body mass index was 23 kg/m2 (18-25).
His blood tests were repeated in the diabetes clinic and he was treated with a basal bolus insulin regimen. Urinalysis was negative for ketones.
Investigations (in diabetes clinic):
haemoglobin A1c110 mmol/mol (20-42)
serum C-peptide200 pmol/L (180-360)
anti-glutamic acid decarboxylase (GAD)
antibodies69 IU/mL (<10)
anti-IA2 antibodiesnegative
What is the most likely diagnosis?

• A. haemochromatosis
• B. maturity-onset diabetes of the young
• C. mitochondrial diabetes mellitus
• D. type 1 diabetes mellitus
• E. latent autoimmune diabetes in adults

A 25-year-old woman presented with a solitary nodule in the right lobe of her thyroid gland.
Investigations:
serum thyroid-stimulating hormone0.45 mU/L (0.4-5.0)
serum free T420.7 pmol/L (10.0-22.0)
The presence of which feature would most increase the likelihood of malignancy?

• A. increased peripheral vascularity of nodule on Doppler ultrasound
• B. microcalcification seen within the nodule on ultrasound scan
• C. size of nodule >1.0 cm in maximum diameter
• D. elevated serum thyroglobulin concentration
• E. high titre of thyroid peroxidase antibodies

A 36-year-old man of South Asian origin presented acutely with a widespread pruritic rash involving the extensor surfaces of the limbs.
On examination, he was moderately obese with a body mass index of 33 kg/m2 (18-25), and the rash was erythematous, with multiple small papules with yellow centres.
Investigations:
fasting plasma glucose11.0 mmol/L (3.0-6.0)
haemoglobin A1c109 mmol/mol (20-42)
serum cholesterol8.0 mmol/L (<5.2)
serum HDL cholesterol0.80 mmol/L (>1.55)
fasting serum triglycerides31.00 mmol/L (0.45-1.69)
What is the most likely diagnosis?

• A. dermatitis herpetiformis
• B. granuloma annulare
• C. eruptive xanthoma
• D. tinea cutis
• E. nodular prurigo

A 69-year-old man with type 2 diabetes mellitus presented with a 3-day history of an ulcer on his right second toe.
On examination, the toe was red, swollen and enlarged, and looked like a 'sausage digit'. The ulcer appeared superficial.
Investigations:
X-ray of right second toeno sign of osteomyelitis
Cultures from the debrided wound bed were taken and the results were awaited.
What is the most appropriate type of antibiotic regimen to start empirically before the culture results are available?

• A. broad spectrum for 10 days
• B. no antibiotic
• C. narrow spectrum for 6 weeks
• D. narrow spectrum for 10 days
• E. broad spectrum for 6 weeks