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MRCPUK SEND Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Topic 1: Thyroid Disease | - Thyroid nodules and cancer - Hyperthyroidism and hypothyroidism |
| Topic 2: Pituitary and Hypothalamic Disorders | - Diabetes insipidus and SIADH - Pituitary adenomas and hypopituitarism |
| Topic 3: Reproductive Endocrinology | - Hypogonadism and infertility - Polycystic ovary syndrome (PCOS) |
| Topic 4: Calcium, Bone and Metabolic Disease | - Calcium and vitamin D disorders - Osteoporosis and metabolic bone disease |
| Topic 5: Neuroendocrine Tumours and Multiple Endocrine Neoplasia | - MEN syndromes - Carcinoid and pancreatic NETs |
| Topic 6: Endocrine Emergencies | - Thyroid and adrenal crisis - Diabetic ketoacidosis and hyperosmolar states |
| Topic 7: Diabetes Mellitus | - Diabetic complications and emergencies - Type 1 and Type 2 diabetes management |
| Topic 8: Adrenal Disorders | - Cushing syndrome - Addison disease and adrenal insufficiency |
| Topic 9: Metabolic Disorders | - Lipid disorders - Obesity management |
MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
A 62-year-old woman was referred with generalised weakness. She had no previous history of note and was not taking any medication. She reported drinking 60 units of alcohol per week.
On examination, she was found to have central adiposity, pale abdominal striae and
wasting of the limb muscles. Her blood pressure was raised at 160/100 mmHg.
Investigations:
serum sodium138 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum cortisol (09.00 h)750 nmol/L (200-700)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol120 nmol/L (<50)
high-dose dexamethasone suppression test (8 mg/day for 48 h):
serum cortisol45 nmol/L (should suppress to
<50% of day 0 value)
24-h urinary free cortisol 360 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)22.0 pmol/L (3.3-15.4)
MR scan of pituitary glandnormal
CT scan of adrenal glands1-cm mass in the left adrenal gland
What is the most likely cause for her presentation?
- A. adrenal carcinoma
- B. adrenal adenoma
- C. Cushing's disease
- D. ectopic adrenocorticotropic hormone syndrome
- E. pseudo-Cushing's syndrome
Correct Answer: E 🗳️
A 55-year-old man with type 2 diabetes mellitus presented with foot swelling and discomfort. He had a peripheral sensory neuropathy attributed to diabetes mellitus. A midfoot Charcot's arthropathy was suspected, and a plain X-ray was arranged (see image).
Which is the talonavicular joint?
- A. 1
- B. 4
- C. 2
- D. 3
- E. 5
Correct Answer: C 🗳️
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. increase bolus insulin with meal
- C. change to twice daily pre-mixed insulin
- D. start glucose 5% with intravenous insulin
- E. start variable-rate intravenous insulin infusion
Correct Answer: B 🗳️
A 26-year-old woman presented with recurrent Graves' disease. After discussing the treatment options, she chose radioiodine.
What dose of radioiodine is most appropriate in uncomplicated Graves' disease?
- A. 1000-1200 MBq
- B. 100-200 MBq
- C. 1400-1600 MBq
- D. 400-600 MBq
- E. 700-900 MBq
Correct Answer: D 🗳️
A 46-year-old man of European descent was reviewed in the diabetes clinic. He had type 2 diabetes mellitus, which had been diagnosed 6 months previously. He had been symptom free and was a non-smoker but had a family history of cardiovascular disease. He exercised regularly and had managed to lose 8 kg.
On examination, his blood pressure was 148/76 mmHg, his weight was 76 kg and his body mass index was 24 kg/m2 (18-25).
Investigations:
urinary albumin:creatinine ratio0.6 mg/mmol (<2.5)
serum cholesterol5.6 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.20 mmol/L (0.45-1.69)
According to NICE guidelines (CG181, July 2014), what is the most appropriate management of his lipid profile?
- A. assess cardiovascular risk using UKPDS risk engine
- B. start nicotinic acid
- C. start a statin
- D. start a fibrate
- E. observe and repeat lipid profile in a few months
Correct Answer: C 🗳️
