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MRCPUK SEND Exam
SEND - Endocrinology and Diabetes (Specialty Certificate Examination) (Page 7 )

Updated On: 7-Feb-2026
Page 7 of 41
PDF with 200 Questions

A 37-year-old man, who had previously undergone female-to-male gender reassignment surgery, attended the endocrine clinic for annual review. He had no complaints and was happy with the results of his treatment. His medication consisted of testosterone undecanoate 1 g intramuscularly every 3 months.
What variable is it most important to monitor?

  1. fasting plasma glucose
  2. haematocrit
  3. serum luteinising hormone
  4. serum prostate-specific antigen
  5. serum testosterone

Answer(s): B



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?

  1. check for macroprolactinaemia
  2. fasting plasma glucose
  3. prescribe sildenafil
  4. prescribe testosterone replacement
  5. serum testosterone (09.00 h)

Answer(s): E



A 42-year-old policewoman presented with thirst, polyuria and tiredness of 3 months’ duration. She gave a family history of thyrotoxicosis.
On examination, her pulse was 108 beats per minute and her blood pressure was 150/70 mmHg. She had a fine tremor and diffuse thyroid enlargement. She also had mild proptosis.
Investigations:

-haemoglobin146 g/L (115–165) platelet count164 ? 109/L (150–400) serum sodium143 mmol/L (137–144) serum creatinine135 µmol/L (60–110)
-serum corrected calcium3.60 mmol/L (2.20–2.60)
-serum thyroid-stimulating hormone<0.02 mU/L (0.4–5.0) serum free T431.9 pmol/L (10.0–22.0)
-serum free T315.6 pmol/L (3.0–7.0)

What is the most appropriate next investigation?

  1. 24-h urinary calcium
  2. fine-needle aspiration of thyroid
  3. isotope bone scan
  4. plasma parathyroid hormone
  5. serum phosphate

Answer(s): D



An 80-year-old man was referred because of weight gain and low mood but said he was otherwise well. He had a complex cardiac history including a ventricular fibrillation arrest and a permanent pacemaker, but he had been very well for the past 3 years. He was taking amiodarone 100 mg daily, lisinopril 40 mg daily and furosemide 80 mg daily.
On examination, he had a pacemaker in situ and his pulse was 84 beats per minute and regular. He had a 2/6 mid-systolic murmur in the aortic area with no radiation, mild ankle oedema, and scanty basal crackles bilaterally on auscultation of his chest.
Investigations (before attending clinic):

-serum thyroid-stimulating hormone19.0 mU/L (0.4–5.0) serum free T411.0 pmol/L (10.0–22.0)
-anti-thyroid peroxidase antibodies300 IU/mL (<50)

What is the most appropriate next step in management?

  1. review with repeat thyroid tests in 3 months
  2. start levothyroxine 25 micrograms daily
  3. start levothyroxine 100 micrograms daily
  4. start liothyronine sodium 10 micrograms twice daily
  5. stop amiodarone

Answer(s): B



A 52-year-old man, with a 20-year history of type 2 diabetes mellitus, had been treated with metformin and, for the previous 4 years, biphasic insulin aspart twice daily. He had recently started a new job that required him to drive a 7.5-tonne vehicle.
If he were to apply for a UK Class C1 driving licence, who should complete the application form with him?

  1. consultant physician specialising in diabetes
  2. diabetes specialist nurse in secondary care
  3. general practitioner
  4. occupational health physician
  5. solicitor

Answer(s): A






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