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MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:

1. 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 umol/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?

A) serum phosphate
B) isotope bone scan
C) 24-h urinary calcium
D) plasma parathyroid hormone
E) fine-needle aspiration of thyroid

2. A 24-year-old woman presented with a 1-year history of secondary amenorrhoea. She also complained of milky discharge from her breasts. She was otherwise well, but had been having difficulty getting pregnant despite regular sexual intercourse. She was taking no medication.
Investigations:
serum prolactin3214 mU/L (<360)
serum thyroid-stimulating hormone2.4 mU/L (0.4-5.0)
serum free T415.6 pmol/L (10.0-22.0)
MR scan of pituitary7-mm left-sided pituitary mass
with no extension beyond the sella
What is the most appropriate licensed therapy in the UK to assist conception?

A) clomifene
B) bromocriptine
C) quinagolide
D) cabergoline
E) gonadotropin therapy

3. A 20-year-old man presented with a 6-month history of lethargy and weakness. His brother had been found to have adrenal failure at the age of 18. He had two sisters who were well and there was no other family history of endocrine autoimmune disease.
On examination, his blood pressure was 100/60 mmHg.
Investigations:
serum sodium136 mmol/L (137-144)
serum potassium4.8 mmol/L (3.5-4.9)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol100 nmol/L
serum cortisol (30 min after tetracosactide)250 nmol/L (>550)
anti-adrenal antibodiesnegative
What is the most important diagnosis to consider?

A) tuberculosis
B) adrenoleucodystrophy
C) isolated adrenocorticotropic hormone deficiency
D) autoimmune hypoadrenalism
E) familial glucocorticoid resistance

4. A 55-year-old man with mild polyuria and tiredness was seen on a renal ward. He had had a living-related kidney transplant 6 months previously. He had good graft function while being treated with prednisolone 5 mg daily, mycophenolate mofetil 1 g twice daily and tacrolimus 3 mg twice daily. He was also taking atenolol 50 mg daily and simvastatin 40 mg daily.
Investigations:
haemoglobin A1c75 mmol/mol (20-42)
random plasma glucose18.0 mmol/L
Which drug is most likely to be responsible for his diabetes of new onset?

A) simvastatin
B) prednisolone
C) atenolol
D) tacrolimus
E) mycophenolate mofetil

5. A 32-year-old woman, with a 22-year history of type 1 diabetes mellitus, was seen in a pre-pregnancy diabetes clinic. She was a primigravida.
On examination, she had early background retinopathy, her blood pressure was 128/68 mmHg, and her body mass index was 29.7 kg/m2 (18-25).
Investigations:
haemoglobin A1c56 mmol/mol (20-42)
urinary albumin:creatinine ratio1.2 mg/mmol (<3.5)
Over the years her haemoglobin A1c concentration had varied between 58 and 69 mmol/mol. She had impaired awareness of hypoglycaemia and experienced approximately two severe hypoglycaemic events per year. She was worried about the risk of severe congenital malformations in her baby.
To what extent will the average risk of severe congenital malformation be increased in infants born to this mother with pregestational diabetes?

A) two-fold
B) eight-fold
C) six-fold
D) four-fold
E) ten-fold

Solutions: