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MRCPUK SEND Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Thyroid Disorders | 15% | - Hyperthyroidism: Graves’ disease, toxic nodular disease - Thyroid nodules and cancer - Hypothyroidism and myxoedema coma - Thyroiditis and subclinical dysfunction |
| Adrenal and Parathyroid/Metabolic Bone Disorders | 15% | - Osteoporosis, osteomalacia, Paget's disease - Hyperparathyroidism, hypoparathyroidism - Primary/secondary hyperaldosteronism - Cushing's syndrome, Addison's disease, phaeochromocytoma |
| Pituitary and Hypothalamic Disorders | 15% | - Hypothalamic dysfunction - Pituitary adenomas: prolactinoma, acromegaly, Cushing's disease - Diabetes insipidus and SIADH - Hypopituitarism and hormone replacement |
| Reproductive and Other Endocrine Conditions | 15% | - Obesity and lipid disorders - Disorders of puberty and sex development - Polycystic ovary syndrome - Endocrine hypertension and rare syndromes |
| Diabetes Mellitus | 40% | - Type 2 Diabetes
|
MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
A 25-year-old woman with type 1 diabetes mellitus was admitted to hospital with a 12-hour
history of nausea and lethargy.
On examination, her temperature was 37.5C, she was dehydrated and her Glasgow coma
score was 14. Urinalysis showed glucose 2+, ketones 3+, protein negative.
Investigations:
white cell count12.0 ? 109/L (4.0-11.0)
neutrophil count8.0 ? 109/L (1.5-7.0)
random plasma glucose22.0 mmol/L
arterial blood gases, breathing air:
pH7.20 (7.35-7.45)
serum C-reactive protein12 mg/L (<10)
She was treated with intravenous sodium chloride 0.9% and fixed-rate intravenous insulin
infusion, and initially improved. Twelve hours into her admission, she complained of a
headache.
On examination, her temperature was 37.3C and her Glasgow coma score was 15. Her
pulse was 85 beats per minute and her blood pressure was 110/70 mmHg. There was no
neck stiffness, papilloedema or focal neurological signs.
What is the most likely cause for her headache?
- A. viral encephalitis
- B. sagittal sinus thrombosis
- C. tension headache
- D. cerebral oedema
- E. bacterial meningitis
Correct Answer: C 🗳️
A 17-year-old boy with a 10-year history of type 1 diabetes mellitus was admitted with diabetic ketoacidosis after a night of binge drinking.
He was treated appropriately with a fixed-rate intravenous insulin infusion and intravenous sodium chloride 0.9%.
Twenty-four hours after admission, he was eating and drinking normally. He was taking his usual doses of subcutaneous insulin and his urinary ketones were undetectable.
Investigations (6 hours previously):
venous blood gases, breathing air: PO25.6 kPa PCO23.8 kPa pH7.29 bicarbonate16 mmol/L base excess-1 mmol/L
lactate1.1 mmol/L
What is the likely most cause of these results?
- A. continued ketonaemia
- B. concurrent aspirin ingestion
- C. hyperchloraemia
- D. hyporeninaemic hypoaldosteronism
- E. alcohol toxicity
Correct Answer: C 🗳️
A 73-year-old man with type 2 diabetes mellitus was referred to the outpatient clinic. He had a history of microalbuminuria and hypertension. He was taking ramipril, amlodipine and metformin.
On examination, his blood pressure was 125/75 mmHg.
Investigations:
haemoglobin A1c57 mmol/mol (20-42)
What additional drug is most likely to prevent glomerular filtration rate decline?
- A. aspirin
- B. simvastatin
- C. losartan
- D. linagliptin
- E. aliskiren
Correct Answer: B 🗳️
A 62-year-old woman with persistent hypertension attended the clinic for review. She had no previous medical history of note and was taking amlodipine, ramipril, bendroflumethiazide, spironolactone and doxazosin. 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)
A blood test for renin and aldosterone concentration was being considered.
For what minimum period should spironolactone be discontinued before this test?
- A. 6 weeks
- B. 1 week
- C. 2 weeks
- D. 72 h
- E. 8 weeks
Correct Answer: A 🗳️
A 24-year-old woman presented with a 1-year history of secondary amenorrhoea. She also complained of milky discharge from her breasts. She was otherwise well, but had been having difficulty getting pregnant despite regular sexual intercourse. She was taking no medication.
Investigations:
serum prolactin3214 mU/L (<360)
serum thyroid-stimulating hormone2.4 mU/L (0.4-5.0)
serum free T415.6 pmol/L (10.0-22.0)
MR scan of pituitary7-mm left-sided pituitary mass
with no extension beyond the sella
What is the most appropriate licensed therapy in the UK to assist conception?
- A. bromocriptine
- B. gonadotropin therapy
- C. cabergoline
- D. quinagolide
- E. clomifene
Correct Answer: A 🗳️
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