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

1. Carbimazole is routinely used in the management of thyroid disease.
What does carbimazole inhibit?

A) sodium/iodide symporter
B) thyroid peroxidase
C) thyroglobulin synthesis
D) presentation of thyroid antigens to autoreactive T cells
E) deiodinase type 1

2. A 36-year-old man of South Asian origin presented acutely with a widespread pruritic rash involving the extensor surfaces of the limbs.
On examination, he was moderately obese with a body mass index of 33 kg/m2 (18-25), and the rash was erythematous, with multiple small papules with yellow centres.
Investigations:
fasting plasma glucose11.0 mmol/L (3.0-6.0)
haemoglobin A1c109 mmol/mol (20-42)
serum cholesterol8.0 mmol/L (<5.2)
serum HDL cholesterol0.80 mmol/L (>1.55)
fasting serum triglycerides31.00 mmol/L (0.45-1.69)
What is the most likely diagnosis?

A) granuloma annulare
B) eruptive xanthoma
C) dermatitis herpetiformis
D) tinea cutis
E) nodular prurigo

3. A 23-year-old barmaid presented with headache, sweating and collapse. She had a past medical history of tension headache and unexplained abdominal pain. Her regular medication included amitriptyline 25 mg at night and paracetamol 1 g as required. She was a smoker and regularly drank alcohol.
On examination, her pulse was 120 beats per minute and her blood pressure was 210/128 mmHg.
Investigations:
24-h urinary metanephrine5.4 umol (<2)
24-h urinary normetanephrine15.2 umol (<3) What substance is most likely to cause assay interference in the measurement of urinary metanephrines?

A) alcohol
B) caffeine
C) amitriptyline
D) nicotine
E) paracetamol

4. A 71-year-old man was brought to the emergency department in a collapsed state. He was
unable to give a history. Records showed that he had ischaemic heart disease and had undergone coronary bypass grafting 2 years previously. He was taking bendroflumethiazide 2.5 mg daily and simvastatin 40 mg at bedtime.
On examination he was unwell. His pulse was 128 beats per minute and his blood pressure was 108/60 mmHg. Oxygen saturation was 96% (94-98) breathing air.
An ECG showed Q waves in leads II, III, and aVF.
Investigations:
serum sodium164 mmol/L (137-144)
serum potassium5.4 mmol/L (3.5-4.9)
serum bicarbonate19 mmol/L (20-28)
serum urea15.2 mmol/L (2.5-7.0)
serum creatinine145 umol/L (60-110)
random plasma glucose81.2 mmol/L
What is the most appropriate fluid replacement?

A) sodium chloride 0.9%
B) colloid
C) compound sodium lactate intravenous infusion
D) sodium chloride 0.9% and glucose 5%
E) sodium chloride 0.45%

5. A 26-year-old woman was urgently referred to clinic with a 6-week history of retroorbital headaches and deteriorating vision. Her past medical history was unremarkable, although on questioning she admitted that she had recently found it increasingly difficult to cope with her busy job.
On examination, her pulse was 60 beats per minute and regular, and her blood pressure was 110/75 mmHg lying and 90/60 mmHg standing. She was pale and had dry skin. Visual acuities were reduced (6/12 right; 6/24 left), and she had a bitemporal inferior quadrantanopia.
Investigations:
serum sodium132 mmol/L (137-144) serum potassium4.0 mmol/L (3.5-4.9)
short tetracosactide Synacthen@ test (250 micrograms): serum cortisol (30 min after tetracosactide)185 nmol/L (>550)
plasma follicle-stimulating hormone2.7 U/L plasma luteinising hormone3.5 U/L serum prolactin1050 mU/L (<360) serum thyroid-stimulating hormone0.3 mU/L (0.4-5.0) serum free T48.0 pmol/L (10.0-22.0)
serum insulin-like growth factor 14.7 nmol/L (7.5-37.3)
MR scan of brainsee image

What is the most likely diagnosis?

A) prolactinoma
B) Rathke's cleft cyst
C) craniopharyngioma
D) non-functioning pituitary adenoma
E) autoimmune hypophysitis

Solutions: