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

1. A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty.
Clinical examination showed central obesity, a body mass index of 32 kg/m2 (18-25) and a blood pressure of 140/90 mmHg.
The following results were obtained within 1 week of her last menstrual period.
Investigations:
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol30 nmol/L (<50)
serum dehydroepiandrosterone sulphate12 umol/L (3-12)
serum androstenedione10.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone38 nmol/L (1-10)
serum oestradiol200 pmol/L (200-400)
serum testosterone3.5 nmol/L (0.5-3.0)
serum sex hormone binding globulin30 nmol/L (40-137)
plasma follicle-stimulating hormone4.0 U/L (2.5-10.0)
plasma luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?

A) ovarian androgen-secreting tumour
B) adrenal androgen-secreting tumour
C) Cushing's syndrome
D) late-onset congenital adrenal hyperplasia
E) polycystic ovary syndrome

2. A 43-year-old man presented with a 2-year history of tiredness and reduced libido. He had not been found to have diabetes mellitus.
On examination, his body mass index was 22.4 kg/m2 (18-25), he was poorly virilised and had 10 mL testes.
Investigations:
serum cortisol (09.00 h)220 nmol/L (200-700) serum testosterone4 nmol/L (9.0-35.0) plasma follicle-stimulating hormone1.2 U/L (1.0-7.0) plasma luteinising hormone1.2 U/L (1.0-10.0) serum prolactin150 mU/L (<360) serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0) serum free T48.2 pmol/L (10.0-22.0)
serum insulin-like growth factor 17.8 nmol/L (5.6-23.3)
MR scan of pituitaryempty sella; no mass lesion
An insulin tolerance test was advised to assess both cortisol and growth hormone reserve.
What is the most appropriate dose of insulin (in units/kg body weight) to administer?

A) 0.01
B) 0.05
C) 1.0
D) 0.5
E) 0.1

3. An 18-year-old man with cystic fibrosis was referred to clinic. Over recent months his lung function had deteriorated and he had lost weight. He was being treated for a chest infection at the time of the consultation.
Investigations:
oral glucose tolerance test (75 g):
fasting plasma glucose8.2 mmol/L (3.0-6.0)
2-h plasma glucose13.5 mmol/L (<7.8)
What is the most appropriate management?

A) start gliclazide
B) repeat oral glucose tolerance test after chest infection has resolved
C) start sitagliptin
D) start insulin
E) restrict refined carbohydrate intake

4. A 62-year-old woman was referred with difficulty in swallowing and a painful, swollen neck.
On examination, her neck was tender to palpation with a small, diffuse goitre. There was no
associated neck lymphadenopathy.
Investigations:
serum thyroid-stimulating hormone<0.04 mU/L (0.4-5.0)
serum free T426.0 pmol/L (10.0-22.0)
serum free T312.0 pmol/L (3.0-7.0)
What is the most likely diagnosis?

A) toxic adenoma
B) haemorrhage into a thyroid cyst
C) thyroid carcinoma
D) Graves' disease
E) subacute thyroiditis

5. A 43-year-old woman was admitted with right lower lobe pneumonia and was found to have atrial fibrillation. She had a history of bipolar disorder for which she was taking lithium. Her menstrual periods were normal.
Investigations on admission:
serum thyroid-stimulating hormone (TSH)0.98 mU/L (0.4-5.0)
serum free T428.1 pmol/L (10.0-22.0)
serum free T314.2 pmol/L (3.0-7.0)
Assay interference had been excluded.
Subsequent investigations:
serum sex hormone binding globulin64 nmol/L (40-137)
serum thyroid-hormone receptor ?-subunit0.8 IU/L (<1.0)
anti-thyroid peroxidase antibodiesnegative
What is the most likely diagnosis?

A) lithium-induced hyperthyroidism
B) TSHoma
C) surreptitious ingestion of thyroxine
D) non-thyroidal illness (sick euthyroid syndrome)
E) thyroid hormone resistance

Solutions: