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

1. A 34-year-old woman presented with palpitations, heat intolerance and a slight tremor. She was 9 weeks into her first pregnancy. She had not had any morning sickness.
On examination, her pulse was 100 beats per minute. She had a small uniform goitre but no tremor and no eye signs.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T442.0 pmol/L (10.0-22.0)
serum free T315.0 pmol/L (3.0-7.0)
anti-thyroid-stimulating hormone receptor
antibodies14 U/L (<7)
The decision was taken to treat her Graves' disease with propylthiouracil (PTU) rather than carbimazole.
What is the reason for this decision?

A) concordance with PTU is greater
B) PTU is less associated with aplasia cutis
C) PTU is less associated with agranulocytosis
D) PTU does not cross the placenta
E) PTU is less associated with hepatitis

2. A 28-year-old man presented to his optician with a 6-month history of gradually deteriorating vision. He was found to have a visual field defect and was referred urgently to an ophthalmologist who confirmed the finding, and arranged the following investigations.
Investigations (at 09.00 h):
serum cortisol300 nmol/L (200-700) serum testosterone6.5 nmol/L (9.0-35.0) plasma follicle-stimulating hormone1.2 U/L (1.0-7.0) plasma luteinising hormone1.3 U/L (1.0-10.0) serum thyroid-stimulating hormone2.4 mU/L (0.4-5.0) serum free T411.1 pmol/L (10.0-22.0)
What is the most important next investigation?

A) short tetracosactide (Synacthen@) test
B) prolactin
C) random growth hormone
D) adrenocorticotropic hormone
E) insulin stress test

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

4. A 37-year-old man, who had previously undergone female-to-male gender reassignment surgery, attended the endocrine clinic for annual review. He had no complaints and was happy with the results of his treatment. His medication consisted of testosterone undecanoate 1 g intramuscularly every 3 months.
What variable is it most important to monitor?

A) serum testosterone
B) haematocrit
C) fasting plasma glucose
D) serum luteinising hormone
E) serum prostate-specific antigen

5. A 50-year-old man with a 9-year history of type 2 diabetes mellitus presented with excessive tiredness. His partner said that he snored excessively. His haemoglobin A1c was usually between 64 and 75 mmol/mol (20-42). He was taking glimepiride 4 mg daily and orlistat. He was intolerant of metformin.
On examination, he had reduced sensation to a 10-g monofilament, and extensive background diabetic retinal changes. His Epworth sleepiness score was 13/24. His body mass index was 36 kg/m2 (18-25) despite compliance with orlistat.
According to the NICE guidelines (CG87, May 2009), what is the most appropriate treatment?

A) dipeptidyl peptidase-4 inhibitor
B) acarbose
C) bariatric surgery
D) basal bolus insulin
E) glucagon-like peptide-1 agonist

Solutions: