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MRCPUK SEND Exam Syllabus Topics:

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

Question 1

A 72-year-old woman was referred for bone density assessment after sustaining a fracture of her right ankle after a minor fall. She had previously fractured her right wrist after tripping in the street. Her past medical history included occasional angina relieved by glyceryl trinitrate spray and a previous deep venous thrombosis. Her medication comprised aspirin, simvastatin, alendronic acid, and calcium and vitamin D, which she had been taking regularly for 2 years.
Investigations:
DXA scan of spine (L2-L4)T score -2.4
DXA scan of total hipT score -2.8
What is the most appropriate treatment?

A. switch alendronic acid to raloxifene
B. switch alendronic acid to teriparatide
C. continue alendronic acid
D. switch alendronic acid to strontium ranelate
E. switch alendronic acid to pamidronate

Question 2

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. clomifene
B. bromocriptine
C. cabergoline
D. quinagolide
E. gonadotropin therapy

Question 3

A 32-year-old man presented to the fertility clinic with his partner. The couple had been together for 4 years and had been trying to conceive for the past 3 years. His partner had children from a previous marriage.
On examination, he was healthy, thin and tall but had bilateral gynaecomastia. His testes felt firm and testicular volumes were 5-6 mL. He had normal pubic and axillary hair.
Investigations:
serum testosterone10.0 nmol/L (9.0-35.0) plasma follicle-stimulating hormone45.0 U/L (1.0-7.0) plasma luteinising hormone32.0 U/L (1.0-10.0)
chromosomal studiesmosaic pattern of 47 XXY/46 XY
semen analysisazoospermia testicular biopsyno viable spermatozoa
What intervention is most likely to lead to conception?

A. artificial insemination by donor
B. pulsatile gonadotropin-releasing hormone
C. human chorionic gonadotropin
D. testosterone
E. intracytoplasmic sperm injection

Question 4

A 54-year-old man was referred from the urology department with erectile dysfunction.
On examination, he had normal secondary sexual characteristics. Testicular volume was
estimated at 15 mL bilaterally.
Investigations:
random plasma glucose8.0 mmol/L
serum testosterone8.1 nmol/L (9.0-35.0) plasma follicle-stimulating hormone3.4 U/L (1.0-7.0) plasma luteinising hormone4.7 U/L (1.0-10.0) serum prolactin410 mU/L (<360)
What is the most appropriate next step in management?

A. check for macroprolactinaemia
B. serum testosterone (09.00 h)
C. fasting plasma glucose
D. prescribe testosterone replacement
E. prescribe sildenafil

Question 5

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. 5 years
B. immediately
C. 10 years
D. 2 years
E. 1 year

Solutions: