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MRCPUK SEND Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Endocrine Emergencies | - Thyroid and adrenal crisis - Diabetic ketoacidosis and hyperosmolar states |
| Metabolic Disorders | - Obesity management - Lipid disorders |
| Calcium, Bone and Metabolic Disease | - Calcium and vitamin D disorders - Osteoporosis and metabolic bone disease |
| Reproductive Endocrinology | - Polycystic ovary syndrome (PCOS) - Hypogonadism and infertility |
| Diabetes Mellitus | - Type 1 and Type 2 diabetes management - Diabetic complications and emergencies |
| Pituitary and Hypothalamic Disorders | - Diabetes insipidus and SIADH - Pituitary adenomas and hypopituitarism |
| Neuroendocrine Tumours and Multiple Endocrine Neoplasia | - MEN syndromes - Carcinoid and pancreatic NETs |
| Thyroid Disease | - Hyperthyroidism and hypothyroidism - Thyroid nodules and cancer |
| Adrenal Disorders | - Addison disease and adrenal insufficiency - Cushing syndrome |
MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
A 66-year-old woman was admitted with carpopedal spasm. During the previous week she had had 2 days of diarrhoea following treatment with ciprofloxacin for a urinary tract infection. She had long-standing rheumatoid arthritis treated with prednisolone 5 mg daily, and was also taking alendronic acid, omeprazole and furosemide.
Investigations:
serum creatinine115 ?mol/L (60-110)
serum corrected calcium1.79 mmol/L (2.20-2.60)
serum alkaline phosphatase124 U/L (45-105)
serum magnesium0.26 mmol/L (0.75-1.05)
plasma parathyroid hormone2.7 pmol/L (0.9-5.4)
Which medicine is most likely to be responsible for her metabolic derangement?
- A. alendronic acid
- B. omeprazole
- C. furosemide
- D. prednisolone
- E. ciprofloxacin
Correct Answer: B 🗳️
A 56-year-old woman presented with a swelling in her neck, which she had noticed by chance 6 weeks previously. The swelling had not changed in size since she first noticed it, and was completely asymptomatic.
On examination, there was a smooth nodule in the thyroid that moved up on swallowing and there was no lymphadenopathy.
Investigations:
ultrasound scan of thyroidsingle 4.7-cm hypoechoic nodule
in upper left lobe
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next step in management?
- A. serial ultrasound examinations
- B. fine-needle aspiration for cytology
- C. hemithyroidectomy
- D. FDG-PET CT scan
- E. isotope uptake scan
Correct Answer: B 🗳️
A 23-year-old man presented with a history of discomfort with his gender for as long as he could remember. He believed he was transsexual.
What element of further history would most strongly support his self-diagnosis?
- A. sexual excitement by cross-dressing
- B. a long-standing intense wish to make his body conform to that of the preferred gender
- C. seeking medical rationalisation for sexuality through genital surgery
- D. the presence of gender somatic delusions that emerge and strengthen with time
- E. conscious and absolute rejection of his sexual orientation as socially unacceptable
Correct Answer: B 🗳️
A 46-year-old Afro-Caribbean man with sarcoidosis was found to have hypercalcaemia and was treated with prednisolone 20 mg/day. Within 3 weeks his serum calcium had fallen to within the reference range.
How do glucocorticoids reduce serum calcium in sarcoidosis?
- A. reduces extrarenal 1-?-hydroxylase activity
- B. suppress parathyroid hormone secretion
- C. promote urinary calcium excretion
- D. direct calcium shift into cells
- E. increase intravascular fluid volume
Correct Answer: A 🗳️
A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty.
Clinical examination showed central obesity, a body mass index of 32 kg/m2 (18-25) and a blood pressure of 140/90 mmHg.
The following results were obtained within 1 week of her last menstrual period.
Investigations:
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol30 nmol/L (<50)
serum dehydroepiandrosterone sulphate12 umol/L (3-12)
serum androstenedione10.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone38 nmol/L (1-10)
serum oestradiol200 pmol/L (200-400)
serum testosterone3.5 nmol/L (0.5-3.0)
serum sex hormone binding globulin30 nmol/L (40-137)
plasma follicle-stimulating hormone4.0 U/L (2.5-10.0)
plasma luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?
- A. polycystic ovary syndrome
- B. ovarian androgen-secreting tumour
- C. Cushing's syndrome
- D. adrenal androgen-secreting tumour
- E. late-onset congenital adrenal hyperplasia
Correct Answer: E 🗳️
