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

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

2. A 67-year-old man underwent an isotope bone scan after being found to have a raised serum alkaline phosphatase (of bone origin). The blood test had been ordered because of mild lower back pain, which had now resolved. He was not taking any medication.
Examination was normal.
Investigations:
isotope bone scansee image

What is the most likely diagnosis?

A) multiple myeloma
B) Paget's disease
C) prostate cancer
D) fibrous dysplasia
E) osteomalacia

3. A 56-year-old man attended routine follow-up for treatment of hypogonadism of late onset. His only medication was testosterone undecanoate (1 g intramuscular injection, every 12 weeks). He had started this treatment 12 months previously and last received the injection 1 week before review.
Digital rectal examination was normal.
Investigations (baseline): haemoglobin145 g/L (130-180) haematocrit0.46 (0.40-0.52) serum prostate-specific antigen0.6 ug/L (<4)
Investigations (12 months after treatment):
haemoglobin153 g/L (130-180) haematocrit0.51 (0.40-0.52) serum prostate-specific antigen5.1 ug/L (<4)
What is the most appropriate next step in management?

A) reassure and repeat blood tests in 12 months
B) check serum testosterone
C) decrease testosterone injection frequency to 14 weeks
D) refer for urological assessment
E) stop testosterone therapy

4. A 25-year-old man presented with a 2-month history of thirst and polyuria. He had minimal weight loss and his body mass index was 26 kg/m2 (18-25). He had had sensorineural deafness since childhood. There was a very strong family history of sensorineural deafness and type 2 diabetes mellitus.
Urinalysis showed no ketones.
Investigations:
random plasma glucose18.0 mmol/L
What is the most appropriate next step in management?

A) test for HFE genotype
B) water deprivation test to assess posterior pituitary function
C) test for mitochondrial diabetes
D) genetic testing for maturity-onset diabetes of the young
E) measurement of glutamic acid decarboxylase antibodies

5. A 36-year-old woman was referred to the endocrine clinic with abnormal thyroid function
tests. She gave a 3-year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder.
Investigations:
serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4-5.0)
serum free T429.8 pmol/L (10.0-22.0)
serum free T33.5 pmol/L (3.0-7.0)
What is the most likely interpretation of her thyroid function test results?

A) TSH-secreting pituitary adenoma
B) factitious thyrotoxicosis
C) resistance to thyroid hormone
D) use of combined oral contraceptive pill
E) assay interference

Solutions: