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MRCPUK SEND Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Endocrine Emergencies | - Thyroid and adrenal crisis - Diabetic ketoacidosis and hyperosmolar states |
| Metabolic Disorders | - Lipid disorders - Obesity management |
| Neuroendocrine Tumours and Multiple Endocrine Neoplasia | - MEN syndromes - Carcinoid and pancreatic NETs |
| Reproductive Endocrinology | - Hypogonadism and infertility - Polycystic ovary syndrome (PCOS) |
| Thyroid Disease | - Thyroid nodules and cancer - Hyperthyroidism and hypothyroidism |
| Adrenal Disorders | - Addison disease and adrenal insufficiency - Cushing syndrome |
| Diabetes Mellitus | - Type 1 and Type 2 diabetes management - Diabetic complications and emergencies |
| Calcium, Bone and Metabolic Disease | - Calcium and vitamin D disorders - Osteoporosis and metabolic bone disease |
| Pituitary and Hypothalamic Disorders | - Diabetes insipidus and SIADH - Pituitary adenomas and hypopituitarism |
MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
A 26-year-old man presented urgently, complaining of muscle pains. He had been found to have heterozygous familial hypercholesterolaemia 2 years previously owing to a mutation in the PCSK9 gene. He had a strong family history of premature vascular disease. He was taking atorvastatin 80 mg daily.
Investigations:
serum creatine kinase2782 U/L (24-195)
serum cholesterol5.7 mmol/L (<5.2)
After stopping atorvastatin, his serum creatine kinase fell to within the normal range.
What is the most appropriate next step in management?
- A. start fluvastatin 40 mg
- B. restart atorvastatin 10 mg
- C. restart atorvastatin 40 mg
- D. start fenofibrate 100 mg
- E. start ezetimibe 10 mg
Correct Answer: A 🗳️
A 46-year-old South Asian man presented with a 2-month history of dry mouth and polyuria. He had hypertension treated with bendroflumethiazide. There was no family history of diabetes mellitus, but his father had died suddenly during lower limb angioplasty at the age of 51.
On examination, the patient's pulse was 76 beats per minute and regular, and his blood pressure was 164/86 mmHg. The rest of the physical examination was normal. Urinalysis was normal.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium3.0 mmol/L (3.5-4.9)
serum creatinine123 umol/L (60-110)
fasting plasma glucose6.9 mmol/L (3.0-6.0)
What is the most appropriate next step in management?
- A. haemoglobin A1c measurement
- B. start oral hypoglycaemic treatment
- C. change bendroflumethiazide to ramipril
- D. oral glucose tolerance test
- E. repeat fasting plasma glucose
Correct Answer: C 🗳️
A 72-year-old woman presented with a painless swelling in the front of the neck, which she had first noticed 2-3 months previously. She was otherwise well, with no symptoms of mass effect in her neck, and was not taking any medication.
On examination, her thyroid gland was moderately enlarged, and felt uniformly nodular. There was no associated lymphadenopathy. Her pulse was 78 beats per minute and regular, and there were no signs of thyrotoxicosis.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T424.8 pmol/L (10.0-22.0)
serum free T310.3 pmol/L (3.0-7.0)
technetium-99m scan of thyroid (20-min uptake)patchy uptake in both thyroid lobes
What is the most appropriate management?
- A. carbimazole plus levothyroxine
- B. partial thyroidectomy
- C. radioiodine
- D. total thyroidectomy
- E. repeat thyroid function tests after 6 months
Correct Answer: C 🗳️
A 16-year-old Caucasian girl presented with a 4-year history of facial hair growth, acne and secondary amenorrhoea.
On examination, her body mass index was 20 kg/m2 (18-25). Her gums and palmar creases were pigmented. Facial hair was evident on her upper lip and chin, and terminal hair was evident on her chest and abdomen. Her Ferriman-Gallwey score was 25. She had acne affecting her face and back.
Investigations:
serum dehydroepiandrosterone sulphate15 umol/L (3-12)
serum androstenedione12.2 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone120 nmol/L (1-10)
serum testosterone6.0 nmol/L (0.5-3.0)
serum sex hormone binding globulin18 nmol/L (40-137)
What treatment is likely to be of most benefit?
- A. cyproterone acetate
- B. fludrocortisone
- C. flutamide
- D. metformin
- E. hydrocortisone
Correct Answer: E 🗳️
A 37-year-old man, who had previously undergone female-to-male gender reassignment surgery, attended the endocrine clinic for annual review. He had no complaints and was happy with the results of his treatment. His medication consisted of testosterone undecanoate 1 g intramuscularly every 3 months.
What variable is it most important to monitor?
- A. haematocrit
- B. serum luteinising hormone
- C. serum testosterone
- D. serum prostate-specific antigen
- E. fasting plasma glucose
Correct Answer: A 🗳️
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