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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: Adrenal Disorders | - Addison disease and adrenal insufficiency - Cushing syndrome |
| Topic 3: Neuroendocrine Tumours and Multiple Endocrine Neoplasia | - Carcinoid and pancreatic NETs - MEN syndromes |
| Topic 4: Calcium, Bone and Metabolic Disease | - Osteoporosis and metabolic bone disease - Calcium and vitamin D disorders |
| Topic 5: Diabetes Mellitus | - Type 1 and Type 2 diabetes management - Diabetic complications and emergencies |
| Topic 6: Metabolic Disorders | - Obesity management - Lipid disorders |
| Topic 7: Reproductive Endocrinology | - Hypogonadism and infertility - Polycystic ovary syndrome (PCOS) |
| Topic 8: Endocrine Emergencies | - Diabetic ketoacidosis and hyperosmolar states - Thyroid and adrenal crisis |
| Topic 9: Thyroid Disease | - Thyroid nodules and cancer - Hyperthyroidism and hypothyroidism |
MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
A 43-year-old man presented with a 2-year history of tiredness and reduced libido. He had not been found to have diabetes mellitus.
On examination, his body mass index was 22.4 kg/m2 (18-25), he was poorly virilised and had 10 mL testes.
Investigations:
serum cortisol (09.00 h)220 nmol/L (200-700) serum testosterone4 nmol/L (9.0-35.0) plasma follicle-stimulating hormone1.2 U/L (1.0-7.0) plasma luteinising hormone1.2 U/L (1.0-10.0) serum prolactin150 mU/L (<360) serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0) serum free T48.2 pmol/L (10.0-22.0)
serum insulin-like growth factor 17.8 nmol/L (5.6-23.3)
MR scan of pituitaryempty sella; no mass lesion
An insulin tolerance test was advised to assess both cortisol and growth hormone reserve.
What is the most appropriate dose of insulin (in units/kg body weight) to administer?
- A. 0.01
- B. 0.1
- C. 0.05
- D. 1.0
- E. 0.5
Correct Answer: B 🗳️
A 23-year-old woman was found to have type 1 diabetes mellitus following a short history of polyuria, polydipsia and unintentional weight loss. She started taking insulin aspart before meals and insulin detemir daily.
What is the most appropriate time from diagnosis to start screening for microalbuminuria?
- A. 10 years
- B. 5 years
- C. 1 year
- D. immediately
- E. 2 years
Correct Answer: B 🗳️
A 19-year-old man was seen in the diabetes clinic. He had lost 2 kg in weight since the diagnosis of diabetes mellitus 18 months previously. At presentation, his body mass index was 33 kg/m2 (18-25), his random plasma glucose was 18.0 mmol/L and his haemoglobin A1c was 56 mmol/mol (20-42). He was taking gliclazide, and metformin had been added later. His father and grandfather had developed diabetes mellitus during their twenties.
Investigations:
haemoglobin A1c56 mmol/mol (20-42)
serum C-peptide301 pmol/L (180-360)
anti-glutamic acid decarboxylase (GAD)
antibodiesnegative
What is the most likely diagnosis?
- A. type 2 diabetes mellitus
- B. type 1 diabetes mellitus
- C. chronic pancreatitis
- D. maturity-onset diabetes of the young
- E. latent-onset diabetes of autoimmunity
Correct Answer: D 🗳️
A 56-year-old man presented with a 6-month history of erectile dysfunction. He had noticed a gradual reduction in his frequency of shaving from daily to twice a week. His libido had diminished and he felt that he was not as strong as he once was. He also described general aches and pains. He was a farm worker and had drunk a bottle of vodka daily for several years, but had stopped drinking 2 years previously. He was a non-smoker.
Investigations:
serum urea6.2 mmol/L (2.5-7.0)
serum creatinine89 umol/L (60-110)
serum albumin40 g/L (37-49)
serum total bilirubin17 umol/L (1-22) serum alanine aminotransferase48 U/L (5-35) serum aspartate aminotransferase37 U/L (1-31) haemoglobin A1c55 mmol/mol (20-42)
serum cortisol (09.00 h)389 nmol/L (200-700) serum testosterone0.7 nmol/L (9.0-35.0) plasma follicle-stimulating hormone2.1 U/L (1.0-7.0) plasma luteinising hormone2.4 U/L (1.0-10.0) serum prolactin458 mU/L (<360) serum thyroid-stimulating hormone3.4 mU/L (0.4-5.0)
MR scan of pituitarysee image
What is the most likely explanation of his symptoms?
- A. cirrhosis of liver
- B. pituitary adenoma
- C. haemochromatosis
- D. age-related hypogonadism
- E. hyperprolactinaemia
Correct Answer: C 🗳️
A 15-year-old boy with a 10-year history of type 1 diabetes mellitus was referred to the adolescent diabetes clinic from the paediatric clinic. Diabetes control had always been satisfactory and his recent haemoglobin A1c concentration was 67 mmol/mol (20-42). He felt generally well, although on a growth chart his weight had fallen steadily from the 50th centile 18 months previously to the 10th centile, and his height had fallen from the 50th centile to the 25th centile. He had stage 4 genital development and stage 4 pubic hair, and testicular volume was 15 mL.
What is the most appropriate investigation?
- A. short tetracosactide (Synacthen@) test
- B. anti-tissue transglutaminase antibodies
- C. thyroid-stimulating hormone and free thyroxine
- D. insulin-like growth factor 1
- E. serum testosterone
Correct Answer: B 🗳️
