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

1. A 53-year-old man with a history of sweats and tremor was found to have abnormal thyroid function tests and a small diffuse goitre. He was treated with carbimazole 20 mg but developed a sore throat after 3 weeks.
Investigations:
haemoglobin150 g/L (130-180)
white cell count2.0 ? 109/L (4.0-11.0)
neutrophil count0.4 ? 109/L (1.5-7.0)
serum thyroid-stimulating hormone<0.02 mU/L (0.4-5.0)
serum free T429.0 pmol/L (10.0-22.0)
thyrotropin receptor antibodiespositive
The carbimazole was stopped; his sore throat resolved and the full blood count normalised.
What is the most appropriate next step in management?

A) treat with Lugol's iodine 5 drops three times daily for 6 months
B) restart carbimazole 5 mg daily
C) early partial thyroidectomy
D) start propylthiouracil 100 mg twice daily
E) early radioactive iodine therapy

2. A 26-year-old physiologist was seen in the diabetes outpatient clinic. She had type 1 diabetes mellitus of 9 months' duration, treated with subcutaneous insulin.
She asked what symptoms of hypoglycaemia she might experience.
In what order are responses to hypoglycaemia most likely to occur as blood glucose falls?

A) neuroglycopenia, autonomic, counter-regulatory hormones
B) autonomic, neuroglycopenia, counter-regulatory hormones
C) counter-regulatory hormones, neuroglycopenia, autonomic
D) counter-regulatory hormones, autonomic, neuroglycopenia
E) autonomic, counter-regulatory hormones, neuroglycopenia

3. A 16-year-old girl presented with primary amenorrhoea. In early childhood she had undergone an inguinal herniorrhaphy. She had no other medical history of note. There was a family history of infertility affecting a maternal aunt.
On examination, she had adult breast development but no pubic or axillary hair. Examination was otherwise normal.
What test is most likely to aid diagnosis?

A) blood karyotype
B) ovarian antibody titres
C) plasma gonadotropins
D) ultrasound scan of pelvis
E) MR scan of pituitary and olfactory bulbs

4. An 18-year-old woman presented with a 2-month history of polyuria and polydipsia. She
had been previously fit and well with regular periods. She was not taking any contraception.
Investigations:
serum potassium5.2 mmol/L (3.5-4.9)
serum corrected calcium2.30 mmol/L (2.20-2.60)
serum cortisol (09.00 h)350 nmol/L (200-700)
She went on to have a water deprivation test, the results of which are detailed below.
time (h)serum osmolality (mosmol/kg)urine osmolality (mosmol/kg) normal: 278-300normal: 100-1000 08.3028952 11.3029282 14.30301153 15.30-172
She was then given intramuscular DDAVP@ 2 micrograms at 16.00 h.
time (h)serum osmolality (mosmol/kg)urine osmolality (mosmol/kg) normal: 278-300normal: 100-1000 16.3030017.30-530 18.30-532
Results from an MR scan of pituitary are shown (see image).

What is the most likely diagnosis?

A) craniopharyngioma
B) Rathke's cleft cyst
C) autoimmune (lymphocytic) hypophysitis
D) non-functioning pituitary adenoma
E) psychogenic polydipsia

5. A 20-year-old woman with Turner's syndrome had heard that there was a risk of ovarian cancer associated with Turner's syndrome. She asked to undergo a pre-emptive oophorectomy.
For what genotype is oophorectomy most likely to be recommended?

A) 45XO
B) 45X/46Xxi (Xq)
C) 45X/46XY
D) 45X/47XXX
E) 45X/46XX

Solutions: