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MRCPUK SEND Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Topic 1: Pituitary and Hypothalamic Disorders | - Pituitary adenomas and hypopituitarism - Diabetes insipidus and SIADH |
| Topic 2: Diabetes Mellitus | - Diabetic complications and emergencies - Type 1 and Type 2 diabetes management |
| Topic 3: Thyroid Disease | - Hyperthyroidism and hypothyroidism - Thyroid nodules and cancer |
| Topic 4: Neuroendocrine Tumours and Multiple Endocrine Neoplasia | - MEN syndromes - Carcinoid and pancreatic NETs |
| Topic 5: Adrenal Disorders | - Addison disease and adrenal insufficiency - Cushing syndrome |
| Topic 6: Calcium, Bone and Metabolic Disease | - Calcium and vitamin D disorders - Osteoporosis and metabolic bone disease |
| Topic 7: Metabolic Disorders | - Lipid disorders - Obesity management |
| Topic 8: Endocrine Emergencies | - Diabetic ketoacidosis and hyperosmolar states - Thyroid and adrenal crisis |
| Topic 9: Reproductive Endocrinology | - Polycystic ovary syndrome (PCOS) - Hypogonadism and infertility |
MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
A 62-year-old woman was admitted with right lower lobe pneumonia. She was taking
amiodarone for atrial fibrillation. Routine thyroid function tests were performed.
Investigations:
serum thyroid-stimulating hormone0.3 mU/L (0.4-5.0)
serum free T427.0 pmol/L (10.0-22.0)
serum free T34.2 pmol/L (3.0-7.0)
anti-thyroid peroxidase antibodies32 IU/mL (<50)
What is the most appropriate interpretation of the thyroid function tests?
- A. subclinical amiodarone-induced thyrotoxicosis
- B. amiodarone effect in a euthyroid patient
- C. amiodarone-induced thyrotoxicosis type II
- D. amiodarone-induced thyrotoxicosis type I
- E. Wolff-Chaikoff effect
Correct Answer: B 🗳️
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. start levothyroxine 100 micrograms daily
- B. start liothyronine sodium 10 micrograms twice daily
- C. stop amiodarone
- D. review with repeat thyroid tests in 3 months
- E. start levothyroxine 25 micrograms daily
Correct Answer: E 🗳️
A 26-year-old woman was urgently referred to clinic with a 6-week history of retroorbital headaches and deteriorating vision. Her past medical history was unremarkable, although on questioning she admitted that she had recently found it increasingly difficult to cope with her busy job.
On examination, her pulse was 60 beats per minute and regular, and her blood pressure was 110/75 mmHg lying and 90/60 mmHg standing. She was pale and had dry skin. Visual acuities were reduced (6/12 right; 6/24 left), and she had a bitemporal inferior quadrantanopia.
Investigations:
serum sodium132 mmol/L (137-144) serum potassium4.0 mmol/L (3.5-4.9)
short tetracosactide Synacthen@ test (250 micrograms): serum cortisol (30 min after tetracosactide)185 nmol/L (>550)
plasma follicle-stimulating hormone2.7 U/L plasma luteinising hormone3.5 U/L serum prolactin1050 mU/L (<360) serum thyroid-stimulating hormone0.3 mU/L (0.4-5.0) serum free T48.0 pmol/L (10.0-22.0)
serum insulin-like growth factor 14.7 nmol/L (7.5-37.3)
MR scan of brainsee image
What is the most likely diagnosis?
- A. non-functioning pituitary adenoma
- B. autoimmune hypophysitis
- C. Rathke's cleft cyst
- D. prolactinoma
- E. craniopharyngioma
Correct Answer: E 🗳️
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. metformin
- B. human chorionic gonadotropin
- C. orlistat
- D. cabergoline
- E. human menopausal gonadotropins
Correct Answer: A 🗳️
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. autosomal dominant
- C. X-linked recessive
- D. X-linked dominant
- E. mitochondrial
Correct Answer: B 🗳️
