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MRCPUK SEND Exam
SEND - Endocrinology and Diabetes (Specialty Certificate Examination) (Page 8 )

Updated On: 12-Jan-2026
Page 8 of 51
PDF with 200 Questions

A 48-year-old man presented with an infected ulcer, measuring 2 ? 1 cm, over the right first metatarsal head, with surrounding cellulitis. He had no previous history of diabetes mellitus but had been told by his general practitioner some years previously that his blood glucose was ‘borderline’.
On examination, his temperature was 37.4°C, his blood pressure was 158/92 mmHg and his body mass index was 31.5 kg/m2 (18–25). His foot pulses were easily palpable but he had a sensory neuropathy.

Investigations:
random plasma glucose16.4 mmol/L haemoglobin A1c81 mmol/mol (20–42)

What is the most appropriate treatment for his hyperglycaemia?

  1. exenatide 5 micrograms twice daily
  2. gliclazide 40 mg twice daily
  3. metformin 500 mg twice daily
  4. sitagliptin 100 mg once daily
  5. soluble insulin before meals, basal insulin at bedtime

Answer(s): C



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



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