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MRCPUK SEND Exam
SEND - Endocrinology and Diabetes (Specialty Certificate Examination) (Page 9 )

Updated On: 12-Jan-2026
Page 9 of 51
PDF with 200 Questions

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



A 56-year-old man with a 5-year history of type 2 diabetes mellitus was worried about developing a foot ulcer. Which clinical feature, if present, best predicts the development of a foot ulcer in a patient with diabetes?

  1. absent foot pulses
  2. absent sensation to a monofilament
  3. history of a previous foot ulcer
  4. inability to perform own foot care
  5. vibration perception threshold >25v

Answer(s): C



A 23-year-old man presented with a history of discomfort with his gender for as long as he could remember. He believed he was transsexual.
What element of further history would most strongly support his self-diagnosis?

  1. a long-standing intense wish to make his body conform to that of the preferred gender
  2. conscious and absolute rejection of his sexual orientation as socially unacceptable
  3. seeking medical rationalisation for sexuality through genital surgery
  4. sexual excitement by cross-dressing
  5. the presence of gender somatic delusions that emerge and strengthen with time

Answer(s): A



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Viewing questions 33 - 36 out of 200 questions



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