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

1. A 64-year-old man, who was undergoing investigation for altered bowel habit, was referred to the endocrine clinic after a CT scan of abdomen had shown a 4-cm mass in his left adrenal gland. He had a history of hypertension and type 2 diabetes mellitus.
Investigations:
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol350 nmol/L (<50)
24-h urinary free cortisol400 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)2.0 pmol/L (3.3-15.4)
He underwent laparoscopic removal of his left adrenal gland.
How should his endocrine condition be managed following surgery?

A) tetracosactide (Synacthen@) test 6 weeks postoperatively and start hydrocortisone if abnormal
B) introduce hydrocortisone and fludrocortisone postoperatively according to blood pressure and electrolytes
C) 24-h urinary cortisol 6 weeks postoperatively and start hydrocortisone if abnormally low
D) start hydrocortisone perioperatively and continue until tetracosactide (Synacthen@) test in 6 weeks
E) immediate postoperative tetracosactide (Synacthen@) test and, if abnormal, start hydrocortisone

2. A 27-year-old woman was referred with abnormal thyroid function tests. She was well and reported no symptoms of thyroid disease apart from occasional palpitations. Her sister had been investigated for a thyroid problem recently. The patient was taking no medication.
Examination was normal.
Investigations:
serum thyroid-stimulating hormone7.6 mU/L (0.4-5.0) serum free T4 28.5 pmol/L (10.0-22.0)
serum free T3 13.6 pmol/L (3.0-7.0)
Her results were confirmed and no evidence of assay interference was reported by the clinical chemist, who indicated that similar thyroid function tests had been obtained 5 years previously.
MR scan of pituitarynormal
What is the most appropriate next investigation?

A) thyrotropin-releasing hormone test
B) sequencing the thyroid-stimulating hormone receptor gene
C) iodine uptake scan
D) serum thyroglobulin
E) sequencing the ?-subunit of the thyroid hormone receptor gene

3. A pregnant 36-year-old woman presented to the diabetes outpatient clinic. She had type 2
diabetes mellitus treated with diet, lifestyle changes and metformin 500 mg twice daily.
On examination, her blood pressure was 128/84 mmHg.
Investigations:
haemoglobin A1c47 mmol/mol (20-42)
urinary albumin:creatinine ratio1.6 mg/mmol (<3.5)
Which is the best agent to reduce the risk of pre-eclampsia in this patient?

A) labetalol
B) omega-3-marine triglycerides
C) aspirin
D) insulin
E) folic acid

4. A 47-year-old nuclear physics professor was referred for advice before taking up an overseas position, overseeing the dismantling of a reactor at the site of a recent nuclear accident. She stated that she would face a small risk of being exposed to significant radioactive contamination during her work and was concerned about her future risk of thyroid cancer.
What is the most appropriate advice?

A) avoid consuming local milk and vegetables
B) take selenium tablets
C) no precautions are necessary for people aged 40 years or over
D) wear lead neck shield while outdoors
E) take potassium iodide tablets

5. A 26-year-old woman with previously well-controlled primary hypothyroidism had been an in patient for treatment of an eating disorder for the previous 6 weeks. She had a history of anaemia resulting from multiple vitamin deficiency and gastric erosions. She had been taking levothyroxine 125 micrograms daily for the previous 5 years; since admission her medication had also included ferrous sulfate, calcium and vitamin D, and sucralfate. Her daily medicines were taken under supervision at 09.00 h. Although she was eating better and had gained 4 kg in weight, she was now complaining of tiredness and feeling "worse than ever".
On examination, she was thin, slightly pale and had no palpable goitre. Recent blood tests had confirmed that her anaemia had resolved.
Investigations:
serum corrected calcium2.28 mmo/L (2.20-2.60)
serum thryoid-stimulating hormone12.0 mU/L (0.4-5.0)
serum free T48.0 pmol/L (10.0-22.0)
serum T30.90 nmol/L (1.07-3.18)
What is the most appropriate next step in management?

A) add liothyronine 20 micrograms daily
B) increase levothyroxine to 175 micrograms daily
C) no change in treatment
D) stop treatment with calcium and vitamin D
E) administer levothyroxine alone at bedtime

Solutions: