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

1. A 16-year-old boy was referred to the endocrine clinic with symptoms of delayed puberty.
On examination, he had a reduced sense of smell, small-sized testes and underdeveloped
secondary sexual characteristics.
Investigations:
serum testosterone3.5 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.5 U/L (1.0-10.0)
serum prolactin220 mU/L (<360)
MR scan of brainnormal
He asked about his future fertility.
What will be the most useful agent for him to achieve fertility?

A) bromocriptine
B) octreotide
C) clomifene
D) gonadotropin-releasing hormones
E) testosterone

2. A 41-year-old man presented to his general practitioner with symptoms of palpitations, sweating and anxiety. His blood pressure was 160/102 mmHg. He was advised to take propranolol 40 mg twice daily but was admitted to hospital later that week with an episode of pulmonary oedema.
On examination at the time of admission, he was noted to be pale and sweating and he had a blood pressure of 210/124 mmHg. A phaeochromocytoma was suspected.
What is the most likely cause of the cardiovascular deterioration following administration of propranolol?

A) propranolol acting as an agonist at ?1-adrenoceptors
B) ?1-adrenoceptor blockade leading to acute left ventricular dysfunction
C) loss of ?2-adrenoceptor-mediated vasodilatation
D) inadequate ?-adrenoceptor blockade because of the short half-life of the drug
E) inhibition of catechol-O-methyltransferase by propranolol leading to an increase in circulating noradrenaline

3. A 36-year-old woman was seen in the clinic with a recurrence of hyperthyroidism after a 2year remission. She had been treated with carbimazole for 18 months following her original presentation. She was moderately symptomatic and was keen to be treated in the same way again. She was planning a pregnancy.
Investigations: serum prolactin240 mU/L (<360) serum thyroid-stimulating hormone<0.1 mU/L (0.4-5.0) serum free T428.0 pmol/L (10.0-22.0)
anti-thyroid-stimulating hormone receptor antibodies44 U/L (<7)
What is the most appropriate next step in management?

A) radioiodine treatment
B) propylthiouracil
C) referral for thyroidectomy
D) carbimazole
E) block-and-replace treatment with carbimazole and levothyroxine

4. A 55-year-old woman presented with thirst, polyuria and polydipsia. Her symptoms had started 9 months previously following a road traffic accident. Her past medical history was normal and she was not taking any regular medication.
On examination, her blood pressure was 130/80 mmHg with no postural drop. Urine volume measured 5 L in 24 hours.
Investigations:
serum sodium131 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea2.0 mmol/L (2.5-7.0) serum corrected calcium2.40 mmol/L (2.20-2.60) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum osmolality278 mosmol/kg (278-300) urinary osmolality100 mosmol/kg (100-1000)
What is the most likely diagnosis?

A) syndrome of inappropriate antidiuretic hormone
B) nephrogenic diabetes insipidus
C) cranial diabetes insipidus
D) primary polydipsia
E) diabetes mellitus

5. A 26-year-old woman was recovering from diabetic ketoacidosis and had been switched to her usual basal bolus insulin regimen. Her capillary blood glucose measurements during the day were high but fasting plasma glucose was in the range 5.0-7.0 mmol/L (3.0-6.0). She was drinking and eating normally.
On examination, her pulse was 76 beats per minute and her blood pressure was 106/66 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum bicarbonate22 mmol/L (20-28)
serum creatinine72 umol/L (60-110)
plasma glucose 2 h after breakfast21 mmol/L
What is the most appropriate next step in management?

A) start glucose 5% with intravenous insulin
B) increase bolus insulin with meal
C) start variable-rate intravenous insulin infusion
D) change to twice daily pre-mixed insulin
E) increase basal insulin at bed time

Solutions: