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

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

2. A 61-year-old woman was referred to the blood pressure clinic because of refractory hypertension. One year previously, her blood pressure, urea and electrolytes had been normal. Her current therapy included verapamil modified-release 240 mg daily and doxazosin 16 mg daily.
On examination, she was 1.63 m tall and weighed 90 kg with an elevated waist to hip ratio. Her blood pressure was 182/94 mmHg supine.
Investigations:
serum sodium137 mmol/L (137-144)
serum potassium2.8 mmol/L (3.5-4.9)
serum creatinine79 umol/L (60-110)
plasma renin activity (after 30 min supine)<1.1 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)<135 pmol/L (135-400)
What is the most appropriate investigation?

A) analysis of the SCNN1B and SCNN1G genes
B) 24-h urinary electrolytes
C) repeat renin and aldosterone concentrations after stopping verapamil for 2 weeks
D) 24-h urine to assess free cortisol:cortisone ratio
E) overnight dexamethasone suppression test

3. A 77-year-old woman presented with a 10-week history of facial hirsutism, scalp hair loss and deepening of the voice.
On examination, her body mass index was 32 kg/m2 (18-25). Her blood pressure was 164/94 mmHg. She had coarse terminal hairs on her upper lip and beard areas. Abdominal examination was normal, but she refused examination of her external genitalia.
Investigations:
serum sodium144 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea7.7 mmol/L (2.5-7.0) serum creatinine122 umol/L (60-110) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum testosterone17.2 nmol/L (0.5-3.0) serum luteinising hormone2.2 U/L (>30.0)
What is the most appropriate initial investigation?

A) serum oestradiol
B) CT scan of abdomen and pelvis
C) plasma adrenocorticotropic hormone and serum cortisol
D) overnight dexamethasone suppression test (after 1 mg dexamethasone)
E) serum dehydroepiandrosterone sulphate

4. A 16-year-old boy was referred to the endocrine clinic. He was concerned about his growth and pubertal development. He was well with no significant medical history. He had felt his development had lagged behind his peers for the previous 2 years and he had been the shortest in his class for some time and was being bullied.
General examination was normal. His height was 1.53 m and weight 52.4 kg. He had Tanner stage 3 genitalia and pubic hair. Axillary hair was present. Testicular volumes were 6 mL bilaterally.
Investigations:
serum testosterone4.4 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone2.5 U/L (1.0-7.0)
plasma luteinising hormone1.8 U/L (1.0-10.0)
serum insulin-like growth factor 134.5 nmol/L (9.3-56.0)
insulin tolerance test:

What is the most appropriate treatment?

A) testosterone 50 mg intramuscularly per month
B) testosterone 250 mg intramuscularly per month
C) growth hormone 0.4 mg subcutaneously per day
D) hydrocortisone 15 mg am, 5 mg pm
E) reassure and review

5. A 56-year-old woman was referred for assessment of asymptomatic hypercalcaemia.
Investigations:
serum corrected calcium2.73 mmol/L (2.20-2.60)
plasma parathyroid hormone8.9 pmol/L (0.9-5.4)
urinary calcium:creatinine clearance ratio0.002
An X-ray of abdomen was normal and imaging of her neck showed no evidence of a
parathyroid adenoma.
What is the pattern of inheritance of this condition?

A) autosomal recessive
B) X-linked dominant
C) autosomal dominant
D) mitochondrial
E) X-linked recessive

Solutions: