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MRCPUK SEND Exam Syllabus Topics:

MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:

Question 1

A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin's lymphoma at the age of 17.
What is the most appropriate investigation?

A. serum testosterone
B. semen analysis
C. testicular biopsy
D. serum follicle-stimulating hormone
E. serum inhibin

Question 2

A 42-year-old woman, with type 1 diabetes mellitus of 22 years' duration, attended for annual review. She was using biphasic insulin twice daily and taking aspirin 75 mg, simvastatin 40 mg and ramipril 10 mg daily.
On examination, her blood pressure was 164/87 mmHg.
Investigations:
serum potassium5.9 mmol/L (3.5-4.9)
serum creatinine197 umol/L (60-110)
estimated glomerular filtration rate (MDRD)26 mL/min/1.73 m2 (>60)
haemoglobin A1c72 mmol/mol (20-42)
urinary albumin:creatinine ratio27.0 mg/mmol (<3.5)
urine culturenegative
What is the most important next step in management?

A. add aliskiren
B. refer to a nephrologist
C. add furosemide
D. check bicarbonate
E. change to intensive insulin regimen

Question 3

A 54-year-old man on the neurosurgery unit developed hyponatraemia 3 days after presenting with a significant head injury. His Glasgow coma score (GCS) had been 6 on admission.
On examination, his GCS was 12. His blood pressure was 124/84 mmHg. There was no
oedema.
Investigations:
serum sodium118 mmol/L (137-144)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine72 umol/L (60-110)
random serum cortisol (08.00 h on day of review)480 nmol/L
serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0)
random urinary sodium60 mmol/L
What is the most appropriate interpretation of these data?

A. intravascular volume depletion
B. they are consistent with syndrome of inappropriate antidiuresis
C. the diagnosis would be helped by measurement of plasma vasopressin concentration
D. the urinary sodium concentration is diagnostic of cerebral salt wasting
E. a short tetracosactide (Synacthen@) test (250 micrograms) is required to exclude secondary hypoadrenalism

Question 4

A 55-year-old male-to-female transsexual was reviewed in clinic. She lived as a woman but had not undergone gender reassignment surgery. She was treated with cyproterone acetate 50 mg twice daily and estradiol 2 mg twice daily.
What are the most important tests for monitoring safe replacement?

A. liver function tests and full blood count
B. lipid profile and liver function tests
C. serum prostate-specific antigen and full blood count
D. lipid profile and serum prostate-specific antigen
E. liver function tests and serum prostate-specific antigen

Question 5

A 25-year-old woman presented with a solitary nodule in the right lobe of her thyroid gland.
Investigations:
serum thyroid-stimulating hormone0.45 mU/L (0.4-5.0)
serum free T420.7 pmol/L (10.0-22.0)
The presence of which feature would most increase the likelihood of malignancy?

A. elevated serum thyroglobulin concentration
B. high titre of thyroid peroxidase antibodies
C. increased peripheral vascularity of nodule on Doppler ultrasound
D. size of nodule >1.0 cm in maximum diameter
E. microcalcification seen within the nodule on ultrasound scan

Solutions: