The Saudi Fellowship final examination in Endocrine and Breast Surgery is a single paper of 80–120 single-best-answer MCQs, blueprinted not by organ but by domain: anatomy and physiology, pathology, diagnostic tests, surgical indications and technique at 17% each, complications at 10% and pharmacology at 5%. The pass score is 70%. Practise one domain at a time, or sit a paper composed in those proportions rather than a random draw from the bank — across breast, thyroid, parathyroid and adrenal disease.
Content reviewed 26 August 2026 against current guidelines.
Start practising freeTaken from the bank, not written for this page. Answer it in your head, then open the explanation.
A 26-year-old man is referred with four months of rapidly progressive, tender enlargement of both breasts, more marked on the right. He takes no prescribed medication, denies anabolic steroids, cannabis and herbal supplements, drinks minimal alcohol, and has a body mass index of 24 kg/m2 with no recent weight change. His performance status is 0. Examination shows firm concentric subareolar discs of about 5 cm bilaterally with no skin tethering or nipple retraction, normal-sized testes with no palpable mass, and no abdominal mass or hepatomegaly. Liver and renal function tests are normal. Which investigation strategy is correct?
Correct answer: C
Gynaecomastia that is rapidly progressive, asymmetrical and occurring in a young man outside the physiological age peaks demands a structured endocrine work-up: beta-hCG (germ cell tumour), testosterone with LH and FSH (primary versus secondary hypogonadism), oestradiol (oestrogen-secreting testicular or adrenal tumour), prolactin, and thyroid, liver and renal function, since thyrotoxicosis, cirrhosis and chronic kidney disease all cause gynaecomastia. Testicular ultrasound is mandatory rather than optional, because Leydig and Sertoli cell tumours are frequently impalpable and normal palpation does not exclude them. Option A: imaging and biopsy address the local disc but miss the systemic cause that will otherwise be discovered late. Option B: prolactin in isolation is a common but poor first move, since hyperprolactinaemia typically produces galactorrhoea and is a much rarer cause of gynaecomastia than the ones above. Option D: karyotyping is appropriate when the testes are small and firm with raised gonadotrophins, which is a result of the panel, not a substitute for it. Option E: cross-sectional imaging is targeted after the biochemistry points to an adrenal or occult source, not used as an unguided fishing expedition.
Teaching point. In young men with progressive gynaecomastia, order the hormone panel and scan the testes anyway — Leydig cell tumours are usually too small to feel.
Referenced to ABS Best Practice Guidelines for the Management of Benign Breast Disease; NICE CKS Gynaecomastia
Every question is explained like this — start with 50 free ›One paper of 80–120 single-best-answer MCQs, plus up to 10% unscored pretest items. Questions are tagged by the domain the Commission examines, so you can drill a single domain or sit a paper weighted the way the real one is.
922 questions carry a blueprint domain. They were assigned by a published rule-based classifier and a hand-audited sample, not by individual expert review of every question, and only assignments above a confidence threshold are counted — the rest of the bank remains available in ordinary practice. SCFHS states that each category may vary by up to five percentage points and that percentages are subject to change; research, ethics, professionalism and patient safety are embedded across the domains rather than examined separately. Always confirm the current blueprint with the Commission.
Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
Scope of authorship. SCFHS-EBS sits outside the author’s own subspecialty practice, which is surgical oncology — peritoneal malignancy, sarcoma, hepatopancreatobiliary and complex pelvic surgery. No diplomate of this board has signed these questions off. What they offer is traceability rather than personal authority: every answer names the current guideline or trial it rests on, so you can check it at the source before you trust it. Found an error? Tell us — it gets corrected or withdrawn.
One written paper of 80 to 120 single-best-answer MCQs, to which up to 10% unscored pretest items may be added. The pass score is 70%; if fewer than 70% of candidates pass, SCFHS lowers it one mark at a time, but never below 65%.
Anatomy and physiology, pathology, diagnostic and investigational tests, surgical indications and techniques of surgery each carry 17%, surgical complications 10% and pharmacology 5%. Each category may vary by up to five percentage points, and research, ethics, professionalism and patient safety are embedded across domains.
Because the blueprint is organised by domain rather than by disease, a purely oncological revision leaves gaps: anatomy, physiology and pharmacology alone account for over a fifth of the paper. Cover breast, thyroid, parathyroid and adrenal disease through each of the seven domains in turn.
Yes — 50 practice questions are free, with no credit card required.
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