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

1. A 28-year-old woman presented to the emergency department with a 3-day history of abdominal pain. Her past medical history included intermenstrual bleeding, and she was undergoing 6-monthly renal ultrasound surveillance for a cystic lesion.
Investigations:
serum creatinine84 umol/L (60-110)
serum corrected calcium3.20 mmol/L (2.20-2.60)
serum phosphate0.7 mmol/L (0.8-1.4)
plasma parathyroid hormone19.5 pmol/L (0.9-5.4)
What is the most likely condition underlying the clinical presentation?

A) multiple endocrine neoplasia type 2B
B) von Hippel-Lindau syndrome
C) Cowden's syndrome
D) multiple endocrine neoplasia type 1
E) hyperparathyroidism-jaw tumour syndrome

2. A 26-year-old physiologist was seen in the diabetes outpatient clinic. She had type 1 diabetes mellitus of 9 months' duration, treated with subcutaneous insulin.
She asked what symptoms of hypoglycaemia she might experience.
In what order are responses to hypoglycaemia most likely to occur as blood glucose falls?

A) neuroglycopenia, autonomic, counter-regulatory hormones
B) autonomic, counter-regulatory hormones, neuroglycopenia
C) autonomic, neuroglycopenia, counter-regulatory hormones
D) counter-regulatory hormones, neuroglycopenia, autonomic
E) counter-regulatory hormones, autonomic, neuroglycopenia

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) high-dose 48-h dexamethasone suppression test
C) CT scan of adrenal glands
D) reassure and discharge
E) MR scan of pituitary

4. A 55-year-old woman was referred with a 6-month history of type 2 diabetes mellitus. She was not taking any regular medication. She was a non-smoker. She drank 10 units of alcohol per week. Her general practitioner had arranged for her to see the community dietician as the patient had made significant changes to her diet.
On examination, she was obese with a body mass index of 31.8 kg/m2 (18-25). Her liver was not palpable.
Investigations:
serum ferritin310 ug/L (15-300)
serum total bilirubin16 umol/L (1-22)
serum alanine aminotransferase80 U/L (5-35)
serum aspartate aminotransferase75 U/L (1-31)
serum alkaline phosphatase150 U/L (45-105)
serum gamma glutamyl transferase35 U/L (4-35)
haemoglobin A1c67 mmol/mol (20-42)
serum cholesterol6.2 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.50 mmol/L (0.45-1.69)
What is the most appropriate management of her dyslipidaemia?

A) simvastatin
B) ezetimibe
C) omega-3-acid ethyl esters
D) fenofibrate
E) metformin

5. A 55-year-old male-to-female transsexual was reviewed in clinic. She lived as a woman but had not undergone gender reassignment surgery. She was treated with cyproterone acetate 50 mg twice daily and estradiol 2 mg twice daily.
What are the most important tests for monitoring safe replacement?

A) liver function tests and serum prostate-specific antigen
B) serum prostate-specific antigen and full blood count
C) liver function tests and full blood count
D) lipid profile and serum prostate-specific antigen
E) lipid profile and liver function tests

Solutions: