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MRCPUK SEND Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Pituitary and Hypothalamic Disorders | 15% | - Pituitary adenomas: prolactinoma, acromegaly, Cushing's disease - Hypothalamic dysfunction - Diabetes insipidus and SIADH - Hypopituitarism and hormone replacement |
| Diabetes Mellitus | 40% | - Other forms of diabetes
|
| Reproductive and Other Endocrine Conditions | 15% | - Disorders of puberty and sex development - Polycystic ovary syndrome - Endocrine hypertension and rare syndromes - Obesity and lipid disorders |
| Adrenal and Parathyroid/Metabolic Bone Disorders | 15% | - Hyperparathyroidism, hypoparathyroidism - Cushing's syndrome, Addison's disease, phaeochromocytoma - Primary/secondary hyperaldosteronism - Osteoporosis, osteomalacia, Paget's disease |
| Thyroid Disorders | 15% | - Thyroid nodules and cancer - Hyperthyroidism: Graves’ disease, toxic nodular disease - Hypothyroidism and myxoedema coma - Thyroiditis and subclinical dysfunction |
MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
A 26-year-old woman presented acutely with abdominal pain. On examination, her blood pressure was 124/72 mmHg.
Investigations:
24-h urinary dopamine10 000 nmol (<3100)
24-h urinary adrenaline43 nmol (<144)
24-h urinary noradrenaline146 nmol (<570)
CT scan of abdomen3-cm left para-aortic mass
She underwent surgical exploration and removal of the lesion, which proved to be a paraganglioma. One local lymph node, removed at the same time, was also positive for the presence of tumour.
What is the most likely underlying genetic syndrome?
- A. Gardner's syndrome
- B. von Hippel-Lindau syndrome
- C. succinate dehydrogenase type B mutation
- D. neurofibromatosis type 1 mutation
- E. multiple endocrine neoplasia type 2a
Correct Answer: C 🗳️
A 56-year-old man attended routine follow-up for treatment of hypogonadism of late onset. His only medication was testosterone undecanoate (1 g intramuscular injection, every 12 weeks). He had started this treatment 12 months previously and last received the injection 1 week before review.
Digital rectal examination was normal.
Investigations (baseline): haemoglobin145 g/L (130-180) haematocrit0.46 (0.40-0.52) serum prostate-specific antigen0.6 ug/L (<4)
Investigations (12 months after treatment):
haemoglobin153 g/L (130-180) haematocrit0.51 (0.40-0.52) serum prostate-specific antigen5.1 ug/L (<4)
What is the most appropriate next step in management?
- A. check serum testosterone
- B. decrease testosterone injection frequency to 14 weeks
- C. reassure and repeat blood tests in 12 months
- D. refer for urological assessment
- E. stop testosterone therapy
Correct Answer: D 🗳️
An 80-year-old man was referred because of weight gain and low mood but said he was otherwise well. He had a complex cardiac history including a ventricular fibrillation arrest and a permanent pacemaker, but he had been very well for the past 3 years. He was taking amiodarone 100 mg daily, lisinopril 40 mg daily and furosemide 80 mg daily.
On examination, he had a pacemaker in situ and his pulse was 84 beats per minute and regular. He had a 2/6 mid-systolic murmur in the aortic area with no radiation, mild ankle oedema, and scanty basal crackles bilaterally on auscultation of his chest.
Investigations (before attending clinic):
serum thyroid-stimulating hormone19.0 mU/L (0.4-5.0)
serum free T411.0 pmol/L (10.0-22.0)
anti-thyroid peroxidase antibodies300 IU/mL (<50)
What is the most appropriate next step in management?
- A. stop amiodarone
- B. start levothyroxine 100 micrograms daily
- C. review with repeat thyroid tests in 3 months
- D. start levothyroxine 25 micrograms daily
- E. start liothyronine sodium 10 micrograms twice daily
Correct Answer: D 🗳️
A pregnant 36-year-old woman presented to the diabetes outpatient clinic. She had type 2
diabetes mellitus treated with diet, lifestyle changes and metformin 500 mg twice daily.
On examination, her blood pressure was 128/84 mmHg.
Investigations:
haemoglobin A1c47 mmol/mol (20-42)
urinary albumin:creatinine ratio1.6 mg/mmol (<3.5)
Which is the best agent to reduce the risk of pre-eclampsia in this patient?
- A. labetalol
- B. omega-3-marine triglycerides
- C. aspirin
- D. insulin
- E. folic acid
Correct Answer: C 🗳️
An 18-year-old man presented to the thyroid clinic complaining of a lump in his neck that had been present for 9 weeks. It was not painful. At the age of 12, he had developed acute lymphoblastic leukaemia and had undergone a bone marrow transplant preceded by total body irradiation and cyclophosphamide.
On examination, he was euthyroid. There was a 1.5-cm firm mass on the left side of the neck, which moved when he swallowed.
Investigations:
serum thyroid-stimulating hormone1.9 mU/L (0.4-5.0)
serum free T416.8 pmol/L (10.0-22.0)
What is the most appropriate initial course of action?
- A. surgical referral for hemithyroidectomy
- B. ultrasound-guided fine-needle aspiration of the nodule
- C. CT scan of neck and thorax
- D. FDG-PET-CT scan
- E. technetium-99m scintigraphy scan of thyroid
Correct Answer: B 🗳️
