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MRCPUK SEND Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Diabetes Mellitus | 40% | - Other forms of diabetes
|
| Thyroid Disorders | 15% | - Hypothyroidism and myxoedema coma - Hyperthyroidism: Graves’ disease, toxic nodular disease - Thyroiditis and subclinical dysfunction - Thyroid nodules and cancer |
| Adrenal and Parathyroid/Metabolic Bone Disorders | 15% | - Osteoporosis, osteomalacia, Paget's disease - Cushing's syndrome, Addison's disease, phaeochromocytoma - Hyperparathyroidism, hypoparathyroidism - Primary/secondary hyperaldosteronism |
| Pituitary and Hypothalamic Disorders | 15% | - Diabetes insipidus and SIADH - Pituitary adenomas: prolactinoma, acromegaly, Cushing's disease - Hypopituitarism and hormone replacement - Hypothalamic dysfunction |
| Reproductive and Other Endocrine Conditions | 15% | - Polycystic ovary syndrome - Endocrine hypertension and rare syndromes - Obesity and lipid disorders - Disorders of puberty and sex development |
MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
A 53-year-old man with a history of sweats and tremor was found to have abnormal thyroid function tests and a small diffuse goitre. He was treated with carbimazole 20 mg but developed a sore throat after 3 weeks.
Investigations:
haemoglobin150 g/L (130-180)
white cell count2.0 ? 109/L (4.0-11.0)
neutrophil count0.4 ? 109/L (1.5-7.0)
serum thyroid-stimulating hormone<0.02 mU/L (0.4-5.0)
serum free T429.0 pmol/L (10.0-22.0)
thyrotropin receptor antibodiespositive
The carbimazole was stopped; his sore throat resolved and the full blood count normalised.
What is the most appropriate next step in management?
- A. early partial thyroidectomy
- B. treat with Lugol's iodine 5 drops three times daily for 6 months
- C. early radioactive iodine therapy
- D. start propylthiouracil 100 mg twice daily
- E. restart carbimazole 5 mg daily
Correct Answer: C 🗳️
A 56-year-old woman was referred for assessment of asymptomatic hypercalcaemia.
Investigations:
serum corrected calcium2.73 mmol/L (2.20-2.60)
plasma parathyroid hormone8.9 pmol/L (0.9-5.4)
urinary calcium:creatinine clearance ratio0.002
An X-ray of abdomen was normal and imaging of her neck showed no evidence of a
parathyroid adenoma.
What is the pattern of inheritance of this condition?
- A. autosomal recessive
- B. X-linked recessive
- C. mitochondrial
- D. X-linked dominant
- E. autosomal dominant
Correct Answer: E 🗳️
A 26-year-old woman was recovering from diabetic ketoacidosis and had been switched to her usual basal bolus insulin regimen. Her capillary blood glucose measurements during the day were high but fasting plasma glucose was in the range 5.0-7.0 mmol/L (3.0-6.0). She was drinking and eating normally.
On examination, her pulse was 76 beats per minute and her blood pressure was 106/66 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum bicarbonate22 mmol/L (20-28)
serum creatinine72 umol/L (60-110)
plasma glucose 2 h after breakfast21 mmol/L
What is the most appropriate next step in management?
- A. increase basal insulin at bed time
- B. start variable-rate intravenous insulin infusion
- C. change to twice daily pre-mixed insulin
- D. increase bolus insulin with meal
- E. start glucose 5% with intravenous insulin
Correct Answer: D 🗳️
A 64-year-old man, who was undergoing investigation for altered bowel habit, was referred to the endocrine clinic after a CT scan of abdomen had shown a 4-cm mass in his left adrenal gland. He had a history of hypertension and type 2 diabetes mellitus.
Investigations:
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol350 nmol/L (<50)
24-h urinary free cortisol400 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)2.0 pmol/L (3.3-15.4)
He underwent laparoscopic removal of his left adrenal gland.
How should his endocrine condition be managed following surgery?
- A. tetracosactide (Synacthen@) test 6 weeks postoperatively and start hydrocortisone if abnormal
- B. immediate postoperative tetracosactide (Synacthen@) test and, if abnormal, start hydrocortisone
- C. start hydrocortisone perioperatively and continue until tetracosactide (Synacthen@) test in 6 weeks
- D. introduce hydrocortisone and fludrocortisone postoperatively according to blood pressure and electrolytes
- E. 24-h urinary cortisol 6 weeks postoperatively and start hydrocortisone if abnormally low
Correct Answer: C 🗳️
A 58-year-old woman was referred with an incidental finding of mild hypercalcaemia. She had no relevant symptoms or significant medical history. She was taking no medication.
Investigations:
serum creatinine101 umol/L (60-110) serum corrected calcium2.71 mmol/L (2.20-2.60) serum alkaline phosphatase78 U/L (45-105)
plasma parathyroid hormone6.8 pmol/L (0.9-5.4) serum 25-OH-cholecalciferol76 nmol/L (45-90)
What is the most appropriate next investigation?
- A. ultrasound scan of neck
- B. parathyroid isotope scan
- C. calcium-sensing receptor gene mutation analysis
- D. bone mineral density scan
- E. calcium:creatinine clearance ratio
Correct Answer: E 🗳️
