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

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

2. A pregnant 36-year-old woman presented to the diabetes outpatient clinic. She had type 2
diabetes mellitus treated with diet, lifestyle changes and metformin 500 mg twice daily.
On examination, her blood pressure was 128/84 mmHg.
Investigations:
haemoglobin A1c47 mmol/mol (20-42)
urinary albumin:creatinine ratio1.6 mg/mmol (<3.5)
Which is the best agent to reduce the risk of pre-eclampsia in this patient?

A) labetalol
B) aspirin
C) folic acid
D) insulin
E) omega-3-marine triglycerides

3. A 44-year-old man was referred for investigation of cortisol excess. He had poorly controlled hypertension, and a long history of type 2 diabetes mellitus with retinopathy and peripheral neuropathy. His medication comprised aspirin, ramipril, atenolol, carbamazepine, metformin and simvastatin.
Initial investigations:
serum cortisol (09.00 h)350 nmol/L (200-700)
serum cortisol (22.00 h)48 nmol/L (50-250)
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol93 nmol/L (<50)
24-h urinary free cortisol (day 1)225 nmol (55-250)
24-h urinary free cortisol (day 2)200 nmol (55-250)
24-h urinary free cortisol (day 3)185 nmol (55-250)
What is the most appropriate next step in management?

A) dexamethasone-suppressed corticotrophin-releasing hormone test
B) CT scan of adrenal glands
C) high-dose 48-h dexamethasone suppression test
D) MR scan of pituitary
E) reassure and discharge

4. A 47-year-old nuclear physics professor was referred for advice before taking up an overseas position, overseeing the dismantling of a reactor at the site of a recent nuclear accident. She stated that she would face a small risk of being exposed to significant radioactive contamination during her work and was concerned about her future risk of thyroid cancer.
What is the most appropriate advice?

A) take potassium iodide tablets
B) avoid consuming local milk and vegetables
C) wear lead neck shield while outdoors
D) no precautions are necessary for people aged 40 years or over
E) take selenium tablets

5. A 45-year-old woman attended for annual follow-up for long-standing hypoparathyroidism (a complication of thyroid surgery 5 years previously). She was asymptomatic. She was taking alfacalcidol 1 microgram daily.
Examination was unremarkable.
Investigations:
serum creatinine105 umol/L (60-110)
serum corrected calcium2.45 mmol/L (2.20-2.60)
24-h urinary calcium9.8 mmol (2.5-7.5)
What is the most appropriate next step in management?

A) decrease alfacalcidol dosage
B) add bendroflumethiazide
C) change alfacalcidol to teriparatide
D) change alfacalcidol to calcitriol
E) recommend low-calcium diet

Solutions: