MRCPUK SEND - Endocrinology and Diabetes (Specialty Certificate Examination) SEND Exam Questions in PDF

A 17-year-old girl with Turner’s syndrome attended the clinic for review. She had been treated with growth hormone therapy for the previous 7 years, and had now reached her final adult height.
What is the most appropriate next step in management?

A 55-year-old man presented with a 3-year history of increasing pain in the right hip. He had been otherwise well and was taking no medication. He was reluctant to consider any intravenous treatment as he had a phobia of needles.

Investigations:
X-ray of hipssclerotic bone in right pubis and ischium suggestive of Paget’s disease

What is the most appropriate oral treatment?

A 43-year-old man presented with a 2-year history of tiredness and reduced libido. He had not been found to have diabetes mellitus.
On examination, his body mass index was 22.4 kg/m2 (18–25), he was poorly virilised and had 10 mL testes.

Investigations:
-serum cortisol (09.00 h)220 nmol/L (200–700) serum testosterone4 nmol/L (9.0–35.0)
-plasma follicle-stimulating hormone1.2 U/L (1.0–7.0) plasma luteinising hormone1.2 U/L (1.0–10.0)
-serum prolactin150 mU/L (<360)
-serum thyroid-stimulating hormone1.2 mU/L (0.4–5.0) serum free T48.2 pmol/L (10.0–22.0)
-serum insulin-like growth factor 17.8 nmol/L (5.6–23.3) MR scan of pituitaryempty sella; no mass lesion

An insulin tolerance test was advised to assess both cortisol and growth hormone reserve. What is the most appropriate dose of insulin (in units/kg body weight) to administer?

A 27-year-old woman presented with oligomenorrhoea and hirsutism, and a 2-year history of infertility. Her body mass index was 26 kg/m2 (18–25). Her partner had a recent normal sperm count and motility test.

Investigations:
-serum androstenedione17.0 nmol/L (0.6–8.8) serum 17-hydroxyprogesterone2 nmol/L (1–10) serum testosterone2.8 nmol/L (0.5–3.0)
-serum sex hormone binding globulin18 nmol/L (40–137) serum follicle-stimulating hormone2.3 U/L (2.5–10.0) serum luteinising hormone8.3 U/L (2.5–10.0)
-serum prolactin152 mU/L (<360)

A diagnosis of polycystic ovary syndrome was made. What is the most effective next step to help her conceive?

An 18-year-old man with cystic fibrosis was referred to clinic. Over recent months his lung function had deteriorated and he had lost weight. He was being treated for a chest infection at the time of the consultation.

Investigations:
-oral glucose tolerance test (75 g):
-fasting plasma glucose8.2 mmol/L (3.0–6.0) 2-h plasma glucose13.5 mmol/L (<7.8)

What is the most appropriate management?