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MRCPUK SEND Exam Syllabus Topics:

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

1. A 20-year-old woman with Turner's syndrome had heard that there was a risk of ovarian cancer associated with Turner's syndrome. She asked to undergo a pre-emptive oophorectomy.
For what genotype is oophorectomy most likely to be recommended?

A) 45X/47XXX
B) 45XO
C) 45X/46XY
D) 45X/46XX
E) 45X/46Xxi (Xq)

2. A 54-year-old woman attended clinic for routine follow-up. She had Cushing's syndrome secondary to ectopic adrenocorticotropic hormone syndrome with no primary source identified.
She had declined bilateral adrenalectomy. Routine medication included metyrapone 500 mg three times daily, ketoconazole 200 mg once daily and hydrocortisone 10 mg in the morning and 5 mg in the evening.
Metyrapone inhibits the action of which enzyme in steroidogenesis?

A) 3?-hydroxysteroid dehydrogenase
B) 17?-hydroxylase
C) 21-hydroxylase
D) 5?-reductase
E) 11?-hydroxylase

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

4. A 16-year-old girl presented with primary amenorrhoea. In early childhood she had undergone an inguinal herniorrhaphy. She had no other medical history of note. There was a family history of infertility affecting a maternal aunt.
On examination, she had adult breast development but no pubic or axillary hair. Examination was otherwise normal.
What test is most likely to aid diagnosis?

A) blood karyotype
B) ultrasound scan of pelvis
C) ovarian antibody titres
D) plasma gonadotropins
E) MR scan of pituitary and olfactory bulbs

5. A 17-year-old boy had panhypopituitarism, including diabetes insipidus, following treatment for a craniopharyngioma. He was taking appropriate replacement therapy. In the transition clinic, he was keen to continue growth hormone replacement therapy following a 12-month break after reaching final height.
Which is the most appropriate test to assess his growth hormone status?

A) growth hormone day profile
B) insulin tolerance test
C) insulin-like growth factor 1
D) clonidine test
E) insulin-like growth factor-binding protein 3

Solutions: