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

Question 1

A 39-year-old man was admitted with severe burns.
On examination, he was noted to be persistently tachycardic.
Investigations:
serum thyroid-stimulating hormone0.2 mU/L (0.4-5.0)
serum free T410.0 pmol/L (10.0-22.0)
serum free T32.5 pmol/L (3.0-7.0)
What is the most appropriate next step in investigation of his thyroid status?

A. thyroid autoantibodies
B. radionuclide thyroid uptake scan
C. thyrotrophin-releasing hormone test
D. reverse tri-iodothyronine
E. repeat blood tests after recovery

Question 2

A 26-year-old man presented urgently, complaining of muscle pains. He had been found to have heterozygous familial hypercholesterolaemia 2 years previously owing to a mutation in the PCSK9 gene. He had a strong family history of premature vascular disease. He was taking atorvastatin 80 mg daily.
Investigations:
serum creatine kinase2782 U/L (24-195)
serum cholesterol5.7 mmol/L (<5.2)
After stopping atorvastatin, his serum creatine kinase fell to within the normal range.
What is the most appropriate next step in management?

A. start fluvastatin 40 mg
B. restart atorvastatin 40 mg
C. restart atorvastatin 10 mg
D. start fenofibrate 100 mg
E. start ezetimibe 10 mg

Question 3

A 24-year-old woman presented with a 1-year history of secondary amenorrhoea. She also complained of milky discharge from her breasts. She was otherwise well, but had been having difficulty getting pregnant despite regular sexual intercourse. She was taking no medication.
Investigations:
serum prolactin3214 mU/L (<360)
serum thyroid-stimulating hormone2.4 mU/L (0.4-5.0)
serum free T415.6 pmol/L (10.0-22.0)
MR scan of pituitary7-mm left-sided pituitary mass
with no extension beyond the sella
What is the most appropriate licensed therapy in the UK to assist conception?

A. cabergoline
B. quinagolide
C. bromocriptine
D. gonadotropin therapy
E. clomifene

Question 4

A 25-year-old woman presented at 28 weeks' gestation after a screening 75-g oral glucose tolerance test, which had shown a fasting plasma glucose of 5.6 mmol/L (3.0-6.0) and a 2h plasma glucose of 9.8 mmol/L (<7.8). She had a family history of type 2 diabetes mellitus and a pre-pregnancy body mass index of 36 kg/m2 (18-25). Home blood glucose monitoring had shown persistently raised blood glucose despite dietary modification. She refused insulin because of needle phobia and was concerned about drug exposure to her unborn child.
The use of what hypoglycaemic therapy is acceptable in this situation?

A. glibenclamide
B. gliclazide
C. sitagliptin
D. pioglitazone
E. exenatide

Question 5

A 45-year-old woman was found to be hypertensive by her general practitioner. She was otherwise well and was not taking any medication. However, she regularly ate health food containing liquorice. There was no family history of significant illness.
On examination, her blood pressure was 170/110 mmHg.
Investigations:
serum sodium140 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine70 umol/L (60-110)
plasma renin activity (after 30 min supine)0.5 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)450 pmol/L (135-400)
During the investigations, her blood pressure was controlled with doxazosin. What is the most likely diagnosis?

A. pseudohyperaldosteronism
B. apparent mineralocorticoid excess
C. primary hyperaldosteronism
D. Gitelman's syndrome
E. renal artery stenosis

Solutions: